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Akıncı S, Çoner A, Akbay E, Adar A, Müderrisoğlu H. Association of the Atherogenic Index of Plasma with C-Reactive Protein and Urinary Albumin Excretion in a Normotensive Nondiabetic Population. Metab Syndr Relat Disord 2022; 20:421-427. [PMID: 35549355 DOI: 10.1089/met.2021.0121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The atherogenic index of plasma (AIP) is an indicator of atherogenic dyslipidemia and is significantly associated with the development of atherosclerotic cardiovascular disease. Previous studies showing the association of AIP with C-reactive protein (CRP) and microalbuminuria included hypertensive and diabetic patients. We aimed to determine the association of AIP with CRP and albuminuria in a normotensive and nondiabetic population. Methods: The study was conducted retrospectively. Two hundred thirty-three individuals without hypertension, diabetes, cardiovascular disease, malignancy, systemic inflammatory disease, nephrological disease, and active infection were determined and included in the study. Urinary albumin excretion was calculated from the albumin-creatinine ratio in fresh spot urine [urinary albumin-creatinine ratio (UACR)]. AIP risk groups were compared in terms of clinical and laboratory findings, and the correlation between AIP and CRP and UACR was evaluated. Results: A total of 233 people, with a mean age of 45.4 years and 139 (69.7%) of whom were male, were included in the study. One hundred thirty-eight (59.2%) individuals were found to be in the low-risk group, 29 (12.5%) in the medium-risk group, and 66 (28.3%) in the high-risk group, according to the AIP value. CRP and UACR were not different between the AIP risk groups (P: 0.141 and 0.441, respectively). A mild correlation was found between AIP and CRP (r: 0.192; P: 0.003), but no correlation was found between AIP and UACR (r: 0.086; P: 0.193). The stepwise linear regression analysis with model adjusted for possible confounders and AIP revealed that only body mass index was a significant predictor of CRP (β: 0.308; P < 0.001), while only systolic blood pressure was a significant predictor of UACR (β: 0.19; P: 0.004), but AIP was not. Conclusions: AIP was not associated with CRP and UACR in normotensive and nondiabetic individuals. This finding suggests that the relationship found in previous studies is related to the presence of hypertension or diabetes rather than the AIP.
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Affiliation(s)
- Sinan Akıncı
- Department of Cardiology, Alanya Application and Research Center, Başkent University Faculty of Medicine, Antalya, Turkey
| | - Ali Çoner
- Department of Cardiology, Alanya Application and Research Center, Başkent University Faculty of Medicine, Antalya, Turkey
| | - Ertan Akbay
- Department of Cardiology, Alanya Application and Research Center, Başkent University Faculty of Medicine, Antalya, Turkey
| | - Adem Adar
- Department of Cardiology, Alanya Application and Research Center, Başkent University Faculty of Medicine, Antalya, Turkey
| | - Haldun Müderrisoğlu
- Department of Cardiology, Başkent University Faculty of Medicine, Ankara, Turkey
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Piona C, Ventrici C, Marcovecchio L, Chiarelli F, Maffeis C, Bonfanti R, Rabbone I. Long-term complications of type 1 diabetes: what do we know and what do we need to understand? Minerva Pediatr (Torino) 2021; 73:504-522. [PMID: 34530587 DOI: 10.23736/s2724-5276.21.06545-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Long-term complications of type 1 diabetes (T1D) include microvascular complications and macrovascular disease. Despite the important advances in the treatment of T1D of the last decades, these complications still represent the leading cause of morbidity and mortality in patients with T1D. Extensive evidence indicates that structural and functional alterations of the kidney, retina, nerves and large arteries occur already in the first years after the onset of diabetes. We performed a comprehensive review of the available evidence on screening, diagnosis, prevention and treatment of vascular complications of T1D. In particular, we focused on three major challenges related to long-term complications of T1D: 1) finding of new biomarkers and diagnostic methods able to identify early signs of complications; 2) identifying specific risk factors for the development of these complications; 3) identifying and implementing new therapeutic strategies able to prevent the development and progression of vascular complications.
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Affiliation(s)
- Claudia Piona
- Paediatric Diabetes and Metabolic Disorders Unit, Regional Center for Paediatric Diabetes, University City Hospital of Verona, Italy
| | - Claudia Ventrici
- Paediatric Unit, Hospital of Polistena, Polistena, Reggio Calabria, Italy
| | | | | | - Claudio Maffeis
- Paediatric Diabetes and Metabolic Disorders Unit, Regional Center for Paediatric Diabetes, University City Hospital of Verona, Italy
| | - Riccardo Bonfanti
- Diabetes Research Institute, Department of Pediatrics, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Ivana Rabbone
- Division of Paediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy -
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Chang YK, Fan HC, Lim PS, Chuang SY, Hsu CC. The relationship between resting heart rate and new-onset microalbuminuria in people with type 2 diabetes: An 8-year follow-up study. Diabet Med 2021; 38:e14436. [PMID: 33095935 PMCID: PMC8246976 DOI: 10.1111/dme.14436] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 10/10/2020] [Accepted: 10/16/2020] [Indexed: 11/29/2022]
Abstract
AIMS Microalbuminuria is an indicator of adverse cardiovascular events and chronic kidney disease. Studies have described an elevated resting heart rate as a risk factor for microalbuminuria in people with cardiovascular disease, but none have clarified its role in microalbuminuria development in people with type 2 diabetes. Therefore, this study investigated the relationship between resting heart rate and new-onset microalbuminuria in type 2 diabetes. METHODS A total of 788 people from a glycaemic control trial in Taiwan were enrolled. Microalbuminuria was defined as a fasting urine albumin-to-creatinine ratio ≥30 mg/g in two consecutive urine tests. Resting heart rate and other covariates were measured at baseline. The quartile of resting heart rates, categorized as <70, 70-74, 75-80 and >80 beats/min, was used for analysis. Cox proportional hazard models were used to evaluate the association between resting heart rate and risk of microalbuminuria. RESULTS During the follow-up period, 244 people (31%) developed microalbuminuria. Those who developed microalbuminuria had a longer diabetes duration (median = 3.0 vs. 2.0 years, p < 0.001), higher rate of hypertension (77% vs. 66%, p = 0.003), higher rate of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker treatment (50% vs. 38%, p = 0.001) and higher baseline HbA1c level (70 vs. 64 mmol/mol, 8.6 vs. 8.0%, p < 0.001). After adjusting for demographics, metabolic profiles and inflammatory markers, developing microalbuminuria was significantly associated with baseline resting heart rate of 70-74, 75-80 and >80 beats/min (with hazard ratios [95% CI] of 2.05 [1.32, 3.18], 2.10 [1.32, 3.32] and 1.62 [1.01, 2.59], respectively) compared to resting heart rates <70 beats/min. An average increased risk of microalbuminuria for increment of 10 beats/min was about 24% among those with hypertension (with hazard ratios of 1.24 [1.05, 1.47] in the multivariable Cox model). CONCLUSIONS This prospective cohort study showed that resting heart rate may be an associative risk factor for developing microalbuminuria in type 2 diabetes.
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Affiliation(s)
- Y. K. Chang
- Department of Medical ResearchTungsTaichung MetroHarbor HospitalTaichungTaiwan
- Department of NursingJenteh Junior College of Medicine, Nursing and ManagementMiaoliTaiwan
| | - H. C. Fan
- Department of Medical ResearchTungsTaichung MetroHarbor HospitalTaichungTaiwan
- Department of PediatricsTungsTaichung MetroHarbor HospitalTaichungTaiwan
- Department of RehabilitationJenteh Junior College of Medicine, Nursing and ManagementMiaoliTaiwan
| | - P. S. Lim
- Division of Renal MedicineTungsTaichung MetroHarbor HospitalTaichungTaiwan
| | - S. Y. Chuang
- Institute of Population Health SciencesNational Health Research InstitutesMiaoliTaiwan
| | - C. C. Hsu
- Institute of Population Health SciencesNational Health Research InstitutesMiaoliTaiwan
- Department of Health Services AdministrationChina Medical UniversityTaichungTaiwan
- Department of Family MedicineMin‐Sheng General HospitalTaoyuanTaiwan
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Role of Microalbuminuria and Hypoalbuminemia as Outcome Predictors in Critically Ill Patients. Crit Care Res Pract 2021; 2021:6670642. [PMID: 33953981 PMCID: PMC8057906 DOI: 10.1155/2021/6670642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/09/2021] [Accepted: 04/01/2021] [Indexed: 11/25/2022] Open
Abstract
Background Assessment of microalbuminuria and hypoalbuminemia can be used as a good tool for the prediction of the ICU outcome in critically ill patients. Purpose To evaluate and compare the prognostic significance of microalbuminuria (albumin creatinine ratio (ACR)) and serum albumin level done on admission and after twenty-four hours for the critically ill patients. Methodology. Sixty ICU patients were involved in a prospective cohort study (mean age was 44.4 ± 16.7 years, and 78.3% were males). Patients were divided into 2 groups according to mortality (survivors and nonsurvivors) and were subjected to laboratory measurement of the mentioned biomarkers on admission and after twenty-four hours. Results There were 34 patients (56.67%) in group A (survivors) and 26 patients (43.33%) in group B (nonsurvivors). Albumin creatinine ratio on admission (ACR1) and albumin creatinine ratio after 24 hours (ACR2) were significantly lower in survivors than nonsurvivors (P values were <0.001 for both). Serum albumin level after 24 hours of admission was significantly higher in survivors than nonsurvivors (P value 0.02) while admission serum albumin was not significantly different between both groups (P value was 0.1). There was a positive correlation between ACR2 and ICU stay and mechanical ventilatory support with a strong positive correlation with the use of vasopressor therapy (r: 0.35, 0.58, and 0.73, respectively). P values were 0.005, <0.0001, and <0.0001, respectively. There was a positive correlation between ACR2 with APACHE II and SOFA scores (r: 0.46 and 0.43, respectively); P values were 0.001 and <0.0001, respectively. There was a moderate negative correlation between serum albumin on admission and after 24 hours and the duration of mechanical ventilation (r: −0.4 and −0.39, respectively) (P values were 0.001 and 0.002, respectively). By Cox regression analysis, two parameters were found to be an independent predictor of mortality in ICU patients which were age and using vasopressor treatment (P values = 0.01 and <0.001), while the other parameters were not independent predictors of mortality (P values were more than 0.05). Conclusions Microalbuminuria on admission and after 24 hours of ICU admission could be a good predictor of mortality in critically ill patients. The serum albumin level after 24 hours of admission can predict poor outcomes in critically ill patients.
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Fernandes Silva L, Vangipurapu J, Smith U, Laakso M. Metabolite Signature of Albuminuria Involves Amino Acid Pathways in 8661 Finnish Men Without Diabetes. J Clin Endocrinol Metab 2021; 106:143-152. [PMID: 32992327 PMCID: PMC7765644 DOI: 10.1210/clinem/dgaa661] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 09/28/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To investigate the metabolite signature of albuminuria in individuals without diabetes or chronic kidney disease to identify possible mechanisms that result in increased albuminuria and elevated risk of type 2 diabetes (T2D). RESEARCH DESIGN AND METHODS The study cohort was a population-based Metabolic Syndrome In Men (METSIM) study including 8861 middle-aged and elderly Finnish men without diabetes or chronic kidney disease at baseline. A total of 5504 men participated in a 7.5-year follow-up study, and 5181 of them had metabolomics data measured by Metabolon's ultrahigh performance liquid chromatography-tandem mass spectroscopy. RESULTS We found 32 metabolites significantly (P < 5.8 × 10-5) and positively associated with the urinary albumin excretion (UAE) rate. These metabolites were especially downstream metabolites in the amino acid metabolism pathways (threonine, phenylalanine, leucine, arginine). In our 7.5-year follow-up study, UAE was significantly associated with a 19% increase (hazard ratio 1.19; 95% confidence interval, 1.13-1.25) in the risk of T2D after the adjustment for confounding factors. Conversion to diabetes was more strongly associated with a decrease in insulin secretion than a decrease in insulin sensitivity. CONCLUSIONS Metabolic signature of UAE included multiple metabolites, especially from the amino acid metabolism pathways known to be associated with low-grade inflammation, and accumulation of reactive oxygen species that play an important role in the pathogenesis of UAE. These metabolites were primarily associated with an increase in UAE and were secondarily associated with a decrease in insulin secretion and insulin sensitivity, resulting in an increased risk of incident T2D.
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Affiliation(s)
- Lilian Fernandes Silva
- Institute of Clinical Medicine, Internal Medicine, University of Eastern Finland, Kuopio, Finland
| | - Jagadish Vangipurapu
- Institute of Clinical Medicine, Internal Medicine, University of Eastern Finland, Kuopio, Finland
| | - Ulf Smith
- Lundberg Laboratory for Diabetes Research, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Markku Laakso
- Institute of Clinical Medicine, Internal Medicine, University of Eastern Finland, Kuopio, Finland
- Kuopio University Hospital, Kuopio, Finland
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A higher level of serum furin indicates a higher risk of microalbuminuria: results from a longitudinal study in Chinese adults. Clin Exp Nephrol 2020; 24:885-892. [PMID: 32770419 DOI: 10.1007/s10157-020-01912-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 06/01/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND Furin, a key enzyme of natriuretic peptide system, has been suggested to play a role in microalbuminuria, but the association between furin and microalbuminuria has been scarcely studied. METHODS Leveraging a longitudinal cohort of Chinese adults who had urinary albumin measured twice 4 years apart, we examined the cross-sectional and prospective associations of baseline serum furin with microalbuminuria, adjusting for age, sex, education level, smoking, drinking, obesity, blood pressure, glucose, lipids, and antihypertensive medications. RESULTS The cross-sectional analysis in 2175 participants (53 ± 10 years, 38% men) found that a 10-time higher level of serum furin was significantly associated with a 64% higher risk of having microalbuminuria (OR = 1.64, P = 0.005). The longitudinal analysis found a positive association between baseline serum furin and dynamic elevation of albumin excretion during follow-up. The prospective analysis in 1357 participants free of microalbuminuria at baseline found that a 10-time higher level of serum furin at baseline was significantly associated with a 1.28-time higher risk of developing microalbuminuria 4 years later (OR = 2.28, P < 0.001). CONCLUSIONS A higher level of serum furin at baseline predicted an increased risk of developing microalbuminuria in Chinese adults. These findings indicate that furin might be a predictor or a risk factor for microalbuminuria but the causality still needs more investigations.
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Zhou Y, Huang Y, Ji X, Wang X, Shen L, Wang Y. Pioglitazone for the Primary and Secondary Prevention of Cardiovascular and Renal Outcomes in Patients with or at High Risk of Type 2 Diabetes Mellitus: A Meta-Analysis. J Clin Endocrinol Metab 2020; 105:5673086. [PMID: 31822895 DOI: 10.1210/clinem/dgz252] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 12/09/2019] [Indexed: 12/15/2022]
Abstract
CONTEXT The goal of the meta-analysis was to evaluate the effect of pioglitazone on the primary and secondary prevention of cardiovascular diseases (CVDs) and renal adverse events in patients with or at high risk of type 2 diabetes mellitus (T2DM). DESIGN Randomized controlled trials (RCTs) comparing pioglitazone with any control were identified through PubMed, Embase, and the Cochrane Library. Cardiovascular outcomes included major adverse cardiovascular events (MACEs, defined as the composite of nonfatal myocardial infarction, nonfatal stroke, and cardiovascular death), hospitalization for heart failure, and all-cause mortality. Renal outcomes included change in urinary albumin to creatinine ratio and 24-hour urinary protein excretion. Weighted mean difference (WMD) and risk ratio (RR) with 95% confidence intervals (CIs) were pooled. RESULTS A total of 26 studies with 19 645 participants were enrolled. Pioglitazone reduced the risk of MACE (RR, 0.8 [95% CI, 0.7-0.9]), with benefit only seen in patients with a history of established CVDs (0.8 [0.7-0.9]) and not in those without (1.0 [0.7-1.3]). Regarding the individual components, pioglitazone reduced the risk of nonfatal myocardial infarction (0.8 [0.6-1.0]) and nonfatal stroke (0.8 [0.7-0.9]), which was confined to patients with a history of established CVDs, whereas no treatment effect was found on cardiovascular death (1.0 [0.7-1.2]) regardless of the presence of established CVDs. Pioglitazone increased the risk of hospitalization for heart failure (1.3 [1.1-1.6]) and had no treatment effect on all-cause mortality (1.0 [0.8-1.1]). Pioglitazone reduced albuminuria by 18.5% (WMD 18.5% [95% CI, 21.1-16.0]), with a similar benefit in patients with different renal function categories. CONCLUSIONS Pioglitazone should be considered in patients with or at high risk of T2DM for the prevention of cardiovascular endpoints, especially in those with a history of established CVD who might benefit the most. Robust reductions in progression of renal disease are seen regardless of baseline renal function degree.
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Affiliation(s)
- Yue Zhou
- Department of Endocrinology, Affiliated Hospital of Medical College Qingdao University, Qingdao, China
| | - Yajing Huang
- Department of Endocrinology, Affiliated Hospital of Medical College Qingdao University, Qingdao, China
| | - Xiaoyun Ji
- Department of Endocrinology, Affiliated Hospital of Medical College Qingdao University, Qingdao, China
| | - Xiang Wang
- Department of Endocrinology, Affiliated Hospital of Medical College Qingdao University, Qingdao, China
| | - Liyan Shen
- Department of Endocrinology, Affiliated Hospital of Medical College Qingdao University, Qingdao, China
| | - Yangang Wang
- Department of Endocrinology, Affiliated Hospital of Medical College Qingdao University, Qingdao, China
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Veiga G, Alves B, Perez M, Alcantara LV, Raimundo J, Zambrano L, Encina J, Pereira EC, Bacci M, Murad N, Fonseca F. NGAL and SMAD1 gene expression in the early detection of diabetic nephropathy by liquid biopsy. J Clin Pathol 2020; 73:713-721. [PMID: 32184218 DOI: 10.1136/jclinpath-2020-206494] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 02/26/2020] [Accepted: 02/27/2020] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Diabetic nephropathy (DN) is a disease that progresses with the slow and progressive decline of the glomerular filtration rate (GFR); the installation of this pathology is silent and one of the major causes of death in patients with diabetes. AIMS To identify new molecular biomarkers for early identification of the onset of DN in patients with type II diabetes mellitus (DM2). We studied the expression profile of the genes; suppressor of mothers against decapentaplegic type 1 (SMAD1), neutrophil gelatinase-associated lipocalin (NGAL) and type IV collagen (COLIV1A) in peripheral blood and urine sediment samples. METHODS Ninety volunteers, 51 with DM2 and 39 healthy, were recruited from the Faculdade de Medicina do ABC outpatient clinic. We conducted an interview and collected anthropometric data, as well as blood and urine samples for biochemical evaluation and real-time PCR amplification of the genes of interest. RESULTS Gene expression data: peripheral blood NGAL (DM2 0.09758±0.1914 vs CTL 0.02293±0.04578), SMAD1 (blood: DM2 0.01102±0.04059* vs CTL 0.0001317±0.0003609; urine: DM2 0.7195±2.344* vs CTL 0.09812±0.4755), there was no significant expression of COLIV1A. These genes demonstrated good sensitivity and specificity in the receiving operating characteristic curve evaluation. CONCLUSION Our data suggest the potential use of NGAL and SMAD1 gene expression in peripheral blood and urine samples as early biomarkers of DN.
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Affiliation(s)
- Glaucia Veiga
- Centro Universitário Saúde ABC/Faculdade de Medicina do ABC, Santo Andre, Brazil
| | - Beatriz Alves
- Centro Universitário Saúde ABC/Faculdade de Medicina do ABC, Santo Andre, Brazil
| | - Matheus Perez
- Centro Universitário Saúde ABC/Faculdade de Medicina do ABC, Santo Andre, Brazil
| | | | - Joyce Raimundo
- Centro Universitário Saúde ABC/Faculdade de Medicina do ABC, Santo Andre, Brazil
| | - Lysien Zambrano
- Universidad Nacional Autónoma de Honduras, Tegucigalpa, Francisco Morazán, Honduras
| | - Jessica Encina
- Centro Universitário Saúde ABC/Faculdade de Medicina do ABC, Santo Andre, Brazil
| | - Edimar Cristiano Pereira
- Pharmaceutical Sciences Department, Universidade Federal de São Paulo, Diadema, São Paulo, Brazil
| | - Marcelo Bacci
- Centro Universitário Saúde ABC/Faculdade de Medicina do ABC, Santo Andre, Brazil
| | - Neif Murad
- Centro Universitário Saúde ABC/Faculdade de Medicina do ABC, Santo Andre, Brazil
| | - Fernando Fonseca
- Centro Universitário Saúde ABC/Faculdade de Medicina do ABC, Santo Andre, Brazil.,Pharmaceutical Sciences Department, Universidade Federal de São Paulo, Diadema, São Paulo, Brazil
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Wang Y, Chen C, Yan Y, Yuan Y, Wang KK, Chu C, Hu JW, Ma Q, Liao YY, Fu BW, Gao K, Sun Y, Lv YB, Zhu WJ, Yang L, Zhang J, Yang RH, Yang J, Mu JJ. Association of uric acid in serum and urine with subclinical renal damage: Hanzhong Adolescent Hypertension Study. PLoS One 2019; 14:e0224680. [PMID: 31730636 PMCID: PMC6857911 DOI: 10.1371/journal.pone.0224680] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 10/18/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The aim of the study was to examine the associations of uric acid (UA) in blood and urine with subclinical renal damage (SRD) and its progression in a Chinese cohort. METHODS 1) 2342 participants from our previously established cohort who were followed up in 2017 were included. Cross-sectional analysis was used to examine the relationships between serum and urinary UA and the risk of SRD. 2) A total of 266 participants were recruited from the same cohort in 2013, and followed up in 2017. Longitudinal analysis was used to determine the relationships of serum and urinary UA with progression of SRD, which was defined as urinary albumin-to-creatinine ratio (uACR) progression or estimated glomerular filtration rate (eGFR) decline. RESULTS In cross-sectional analysis, higher levels of uACR were associated with higher levels of serum uric acid (SUA) and urinary uric acid/creatinine ratio (uUA/Cre). Lower eGFR was associated with higher levels of SUA and fractional excretion of uric acid (FEUA) but lower uUA/Cre levels in all subjects. In addition, the multivariate-adjusted odds ratios for SRD compared with non-SRD were 3.574 (2.255-5.664) for uUA/Cre. Increasing uUA/Cre levels were associated with higher risk of SRD. In longitudinal analysis, 4-year changes of uUA/Cre and SUA were significantly associated with eGFR decline. CONCLUSIONS This study suggested that urinary UA excretion was significantly associated with the risk of SRD in Chinese adults. Furthermore, 4-year changes of serum and urinary UA were associated with SRD progression. These findings suggest that UA, especially urinary UA, may be used as a simple, noninvasive marker for early detection of decreased renal function in otherwise healthy subjects.
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Affiliation(s)
- Yang Wang
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi’an, China
| | - Chen Chen
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Yu Yan
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi’an, China
| | - Yue Yuan
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Ke-Ke Wang
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi’an, China
| | - Chao Chu
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi’an, China
| | - Jia-Wen Hu
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi’an, China
| | - Qiong Ma
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi’an, China
| | - Yue-Yuan Liao
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi’an, China
| | - Bo-Wen Fu
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Ke Gao
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Yue Sun
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Yong-Bo Lv
- Department of Cardiology, Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Wen-Jing Zhu
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Lei Yang
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Jie Zhang
- Department of Cardiology, Xi’an Fourth People’s Hospital, Xi’an, China
| | - Rui-Hai Yang
- Institute of Cardiovascular Sciences, Hanzhong People’s Hospital, Hanzhong, China
| | - Jun Yang
- Institute of Cardiovascular Sciences, Hanzhong People’s Hospital, Hanzhong, China
| | - Jian-Jun Mu
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi’an, China
- * E-mail:
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Vadalà M, Castellucci M, Guarrasi G, Terrasi M, La Blasca T, Mulè G. Retinal and choroidal vasculature changes associated with chronic kidney disease. Graefes Arch Clin Exp Ophthalmol 2019; 257:1687-1698. [PMID: 31147842 DOI: 10.1007/s00417-019-04358-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 05/04/2019] [Accepted: 05/14/2019] [Indexed: 01/13/2023] Open
Abstract
PURPOSE Retinal and choroidal microvascular changes can be related to renal impairment in hypertension and chronic kidney disease (CKD). The study examines the association between retinochoroidal parameters and renal impairment in hypertensive, non-diabetic patients. METHODS This is a cross-sectional study on Caucasian patients with systemic arterial hypertension with different levels of renal function. All subjects were studied by blood chemistry, urine examination, microalbuminuria and blood pressure. Complete eye examination was completed with swept source optical coherence tomography (SS-OCT) and optical coherence tomography angiography (OCTA) scans of macular region. Patients were divided in groups: LowGFR and HighGFR and CKD- and CKD+, according to the value of glomerular filtrate (GFR) and albuminuria. LowGFR and CKD+ groups included patients with clinical kidney impairment. RESULTS One hundred and twenty eyes of 120 hypertensive patients were evaluated. The mean retinal thickness was thinner in CKD+ versus CKD- group (p < 0.009). LowGFR and CKD+ groups showed thinner choroidal values than HighGFR (p < 0.02) and CKD- (p < 0.001) groups. OCTA showed lower density in LowGFR than in HighGFR group (p < 0.001) and in CKD+ versus CKD- group (p < 0.001). Albuminuria was inversely related to choroidal and retinal thickness measures (p < 0.001) and to the indices of superficial parafoveal (p < 0.05) and foveal (p < 0.05) vascular densities. CONCLUSIONS CKD is associated with retinal thinning, eGFR and decreasing renal function with progressive reduction of choroidal and retinal vascular density. SS-OCT and OCTA documented close association between CKD and reduction of both choroidal thickness and paracentral retinal vascular density in hypertensive patients.
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Affiliation(s)
- Maria Vadalà
- Dipartimento di Biomedicina Sperimentale e Neuroscienze cliniche, Sezione di Oftalmologia, University of Palermo, Via Liborio Giuffrè 13, 90127, Palermo, Italy.
| | - Massimo Castellucci
- Dipartimento di Biomedicina Sperimentale e Neuroscienze cliniche, Sezione di Oftalmologia, University of Palermo, Via Liborio Giuffrè 13, 90127, Palermo, Italy
| | - Giulia Guarrasi
- Dipartimento di Biomedicina Sperimentale e Neuroscienze cliniche, Sezione di Oftalmologia, University of Palermo, Via Liborio Giuffrè 13, 90127, Palermo, Italy
| | - Micol Terrasi
- Dipartimento di Biomedicina Sperimentale e Neuroscienze cliniche, Sezione di Oftalmologia, University of Palermo, Via Liborio Giuffrè 13, 90127, Palermo, Italy
| | - Tiziana La Blasca
- Dipartimento Biomedico di Medicina Interna e Specialistica, Università di Palermo, Palermo, Italy
| | - Giuseppe Mulè
- Dipartimento Biomedico di Medicina Interna e Specialistica, Università di Palermo, Palermo, Italy
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Tang X, You J, Liu D, Xia M, He L, Liu H. 5-Hydroxyhexanoic Acid Predicts Early Renal Functional Decline in Type 2 Diabetes Patients with Microalbuminuria. Kidney Blood Press Res 2019; 44:245-263. [DOI: 10.1159/000498962] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 01/14/2019] [Indexed: 11/19/2022] Open
Abstract
Background/Aims: Diabetic nephropathy (DN) is a leading cause of end-stage renal disease. Microalbuminuria (MA) is widely used to predict early progressive renal function decline (ERFD) of DN in type 2 diabetes mellitus (T2D) patients, but the sensitivity and specificity of MA have been questioned. Here, we determined the urine metabolites differences between T2D patients with MA who maintained stable renal function and those who progressed to ERFD in order to identify specific biomarkers of the progression of renal dysfunction. Methods: A total of 102 T2D patients with MA and normal renal function at baseline were followed up for 5–6 years. Of these, 52 patients were selected and classified into two groups according to the later renal function; 25 patients who experienced ERFD were regarded as the progressive group, while 27 patients who maintained stable renal function were considered as the stable group. In the pilot study, untargeted, broad-spectrum urine metabolomics was performed on the urine of 12 subjects from the progressive group (5 patients as “progressors”) and stable group (7 patients as “non-progressors”) to discover candidate markers. We then used a targeted metabolomics analysis to identify the selected markers in the urine of an additional 40 patients (20 from the progressive group as cases, and 20 from the stable group as controls) in the validation study. Results: A total of 318 known metabolites were detected in the pilot study and 6 metabolites with significant difference between progressors and non-progressors were identified. The levels of 4 metabolites, including azelaic acid, adipic acid, 5-hydroxyhexanoic acid, and L-tryptophan decreased significantly, while levels of L-pyroglutamic acid and D-norvaline increased observably in the progressors compared with non-progressors. Furthermore, in the validation study, 6 metabolites were confirmed by quantitative measurements and their concentrations were consistent with the changes in the pilot study. Concentrations of L-pyroglutamic acid and D-norvaline still increased in the cases, but were not statistically significant. Of the 4 metabolites with decreased concentrations among the cases, only 5-hydroxyhexanoic acid remained statistically significant while the other 3 metabolites did not differ between cases and controls. Conclusion: We have identified urine metabolites and shown that 5-hydroxyhexanoic acid can be used as a predictor of progression of ERFD in T2D patients with MA. This finding provides the new perspective that 5-hydroxyhexanoic acid may be useful to identify T2D patients with MA who are at risk of ERFD.
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12
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Mao W, Jin X, Wang H, Ye Y, Zhang L, Gu S, Wang J, Ning G, Mu Y. The Association between Resting Heart Rate and Urinary Albumin/Creatinine Ratio in Middle-Aged and Elderly Chinese Population: A Cross-Sectional Study. J Diabetes Res 2019; 2019:9718370. [PMID: 31534974 PMCID: PMC6732617 DOI: 10.1155/2019/9718370] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 07/29/2019] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE In general population, resting heart rate (RHR) is associated with cardiovascular disease. However, its relation to chronic kidney disease (CKD) is debated. We therefore investigated the relationship between RHR and urinary albumin/creatinine ratio (UACR, an indicator of early kidney injury) in general population at different levels of blood pressure and blood glucose. METHODS We screened out 32,885 subjects from the REACTION study after excluding the subjects with primary kidney disease, heart disease, tumor history, related drug application, and important data loss. The whole group was divided into four groups (Q1: RHR ≤ 71, Q2: 72 ≤ RHR ≤ 78, Q3: 79 ≤ RHR ≤ 86, and Q4: 87 ≤ RHR) according to the quartile of average resting heart rate. The renal function was evaluated by UACR (divided by quartiles of all data in the center to which the subject belonged). Ordinary logistic regression was carried out to explore the association between RHR and UACR at diverse blood pressure and blood glucose levels. RESULTS The subjects with higher RHR quartile tend to have a higher UACR, even multifactors were adjusted. After stratifying the subjects according to blood pressure and blood glucose, the positive relationship between RHR and UACR remained in the subjects with normal blood pressure and normal glucose tolerance, while in the hypertension (SBP ≥ 140 mmHg and/or DBP ≥ 90 mmHg) group and the diabetic mellitus (FPG ≥ 7.0 mmol/L and/or PPG ≥ 11.1 mmol/L) group, the relationship disappeared. In the subjects without hypertension, compared with the Q1 group, the UACR is significant higher in the Q3 group (OR: 1.11) and the Q4 group (OR: 1.22). In the subjects with normal glucose tolerance (NGT), compared with the Q1 group, the UACR is significantly higher in the Q3 group (OR: 1.13) and the Q4 group (OR: 1.19). CONCLUSIONS The population with higher RHR tend to have a higher UACR in the normal blood pressure group and the normal glucose tolerance group.
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Affiliation(s)
- Wenfeng Mao
- Department of Endocrinology, Chinese People's Liberation Army General Hospital, No. 28 Fuxing Road, Beijing 100853, China
- School of Medicine, Nankai University, No. 94 Weijin Road, Tianjin 300071, China
| | - Xinye Jin
- Department of Endocrinology, Chinese People's Liberation Army General Hospital, No. 28 Fuxing Road, Beijing 100853, China
| | - Haibin Wang
- Department of Endocrinology, Chinese People's Liberation Army General Hospital, No. 28 Fuxing Road, Beijing 100853, China
| | - Yingnan Ye
- Department of Endocrinology, Chinese People's Liberation Army General Hospital, No. 28 Fuxing Road, Beijing 100853, China
- School of Medicine, Nankai University, No. 94 Weijin Road, Tianjin 300071, China
| | - Linxi Zhang
- Department of Endocrinology, Chinese People's Liberation Army General Hospital, No. 28 Fuxing Road, Beijing 100853, China
| | - Shi Gu
- Department of Endocrinology, Chinese People's Liberation Army General Hospital, No. 28 Fuxing Road, Beijing 100853, China
- School of Medicine, Nankai University, No. 94 Weijin Road, Tianjin 300071, China
| | - Jie Wang
- Department of Endocrinology, Chinese People's Liberation Army General Hospital, No. 28 Fuxing Road, Beijing 100853, China
- School of Medicine, Nankai University, No. 94 Weijin Road, Tianjin 300071, China
| | - Guang Ning
- Department of Endocrinology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - Yiming Mu
- Department of Endocrinology, Chinese People's Liberation Army General Hospital, No. 28 Fuxing Road, Beijing 100853, China
- School of Medicine, Nankai University, No. 94 Weijin Road, Tianjin 300071, China
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Pavlakou P, Dounousi E, Roumeliotis S, Eleftheriadis T, Liakopoulos V. Oxidative Stress and the Kidney in the Space Environment. Int J Mol Sci 2018; 19:ijms19103176. [PMID: 30326648 PMCID: PMC6214023 DOI: 10.3390/ijms19103176] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 10/08/2018] [Accepted: 10/12/2018] [Indexed: 12/12/2022] Open
Abstract
In space, the special conditions of hypogravity and exposure to cosmic radiation have substantial differences compared to terrestrial circumstances, and a multidimensional impact on the human body and human organ functions. Cosmic radiation provokes cellular and gene damage, and the generation of reactive oxygen species (ROS), leading to a dysregulation in the oxidants–antioxidants balance, and to the inflammatory response. Other practical factors contributing to these dysregulations in space environment include increased bone resorption, impaired anabolic response, and even difficulties in detecting oxidative stress in blood and urine samples. Enhanced oxidative stress affects mitochondrial and endothelial functions, contributes to reduced natriuresis and the development of hypertension, and may play an additive role in the formation of kidney stones. Finally, the composition of urine protein excretion is significantly altered, depicting possible tubular dysfunction.
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Affiliation(s)
- Paraskevi Pavlakou
- Department of Nephrology, Medical School, University of Ioannina, 45110 Ioannina, Greece.
| | - Evangelia Dounousi
- Department of Nephrology, Medical School, University of Ioannina, 45110 Ioannina, Greece.
| | - Stefanos Roumeliotis
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece.
| | - Theodoros Eleftheriadis
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece.
| | - Vassilios Liakopoulos
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece.
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14
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Mukai H, Ming P, Lindholm B, Heimbürger O, Barany P, Anderstam B, Stenvinkel P, Qureshi AR. Restrictive lung disorder is common in patients with kidney failure and associates with protein-energy wasting, inflammation and cardiovascular disease. PLoS One 2018; 13:e0195585. [PMID: 29702682 PMCID: PMC5922538 DOI: 10.1371/journal.pone.0195585] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 03/26/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Cardiovascular disease (CVD), protein-energy wasting (PEW), and inflammation are common interrelated features of chronic kidney disease (CKD). Less is known about lung dysfunction in CKD and its possible role in this context. We evaluated lung function and its association with estimated glomerular filtration rate (GFR), CVD, PEW, and inflammation in individuals with normal to severely reduced GFR. METHODS In 404 individuals with GFR category G1 (n = 31; GFR >90mL/min/1.73 m2), G2 (n = 46), G3 (n = 33), G4 (n = 49) and G5 (n = 245; GFR<15mL/min/1.73 m2), pulmonary function was assessed by spirometry. Obstructive (OLD) and restrictive (RLD) lung dysfunction was defined based on forced vital capacity (FVC), forced expiratory volume in the first second (FEV1) and peak expiratory flow (PEF), expressed as percentages of predicted values (%FEV1, %FVC and %PEF, respectively). PEW was evaluated by subjective global assessment, handgrip strength (HGS) and lean body mass index (LBMI), and inflammation by interleukin-6 and high sensitivity C-reactive protein. RESULTS RLD (defined as FEV1/FVC ≥ 0.70 and %FVC<80) associated with GFR and was present in 36% of G5 and 14% of G1-4 individuals. OLD (FEV1/FVC<0.70) was less common with similar prevalence among G1-4 (9%) and G5 (11%) individuals. Notably, 64% of those with concomitant presence of PEW, inflammation and clinical signs of CVD had RLD while 79% of those lacking these complications had normal lung function. In multivariate logistic regression analysis, RLD associated with CVD, PEW and inflammation, after adjusting for Framingham's CVD risk score, serum albumin, and GFR category. CONCLUSIONS RLD is a common complication in patients with advanced CKD, especially in those with concomitant presence of CVD, inflammation and PEW. RLD appears to be an integral albeit scarcely explored consequence of pulmonary-renal interactions in CKD patients.
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Affiliation(s)
- Hideyuki Mukai
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Pei Ming
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Renal Department, First affiliated Teaching Hospital, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Bengt Lindholm
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Olof Heimbürger
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Peter Barany
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Björn Anderstam
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Peter Stenvinkel
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Abdul Rashid Qureshi
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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15
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Renal Evaluation in Common Variable Immunodeficiency. J Immunol Res 2018; 2018:5841031. [PMID: 29736405 PMCID: PMC5874972 DOI: 10.1155/2018/5841031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 12/21/2017] [Accepted: 01/08/2018] [Indexed: 12/18/2022] Open
Abstract
Introduction Common variable immunodeficiency (CVID) comprises a heterogeneous group of disorders characterized by impaired antibody production. Kidney involvement in CVID is described in isolated and sporadic case reports. The objective of this study was to study the renal function pattern in CVID patients through glomerular and tubular function tests. Methods Study of 12 patients with CVID diagnosis and 12 healthy control individuals. Glomerular filtration rate (GFR), fractional excretion of sodium (FENa+) and potassium (FEK+), urinary concentration, and acidification capacity were measured. In addition, microalbuminuria and urinary monocyte chemoattractant protein-1 (MCP-1) were evaluated as markers of selectivity of the glomerular barrier and inflammation, respectively. Results In relation to glomerular markers, all CVID patients had normal GFR (>90 mL/min/1.73 m2), and microalbuminuria and urinary MCP-1 levels were also similar to those of controls. Interestingly, CVID patients had reduced urinary concentration capacity, as demonstrated by lower U/POsm ratio, when compared to controls. Also, while all control subjects achieved a urinary pH less than 5.3, no CVID patients showed a decrease in urinary pH to such levels in response to acid loading with CaCl2, characterizing impaired urinary acidification capacity. Conclusion Patients showed a trend towards an elevated prevalence of tubular dysfunction, mainly related to urinary acidification and concentration capacities.
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16
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Feng L, Nian S, Zhang S, Xu W, Zhang X, Ye D, Zheng L. The associations between serum biomarkers and stenosis of the coronary arteries. Oncotarget 2018; 7:39231-39240. [PMID: 27250030 PMCID: PMC5129928 DOI: 10.18632/oncotarget.9645] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 05/16/2016] [Indexed: 11/27/2022] Open
Abstract
Serum biochemical indices reflect dynamic physiological and pathophysiological processes within the body, the associations between these markers and the number of stenotic coronary arteries have been rarely studied. 627 healthy controls and 1,049 coronary heart disease (CHD) patients were sequentially recruited in our hospital. The association patterns between serum biochemical markers and the numbers of stenotic coronary arteries were evaluated in a cross-sectional manner. Upon binary multiple logistic regression analysis, the risk factor patterns differed by gender. Age, high-density lipoprotein cholesterol (HDL) and homocysteine (HCY) were common risk factors for CHD in both males and females. Upon ordinal multiple logistic regression analysis, age, low-density lipoprotein cholesterol (LDL) and lipoprotein (Lp) (a) increased, and HDL decreased, as the number of stenotic coronary arteries increased in male patients. Age and Lp(a) were positively associated with the number of stenotic coronary arteries and total bilirubin (TBil) was negatively associated with the number of stenotic coronary arteries in female patients. Age and Lp(a) were common risk factors positively associated with the number of stenotic coronary arteries in both male and female patients. HDL and LDL were male-specific risk factors and TBil was a female-specific risk factor for an increasing number of stenotic coronary arteries. In conclusion, serum biomarker levels correlated with the number of stenotic coronary arteries and showed gender different patterns.
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Affiliation(s)
- Lei Feng
- Department of Laboratory, People's Hospital of Yuxi City, Yuxi City, Yunnan, P.R. China.,Department of Laboratory Medicine, Nanfang Hospital, Southern Medical University, Baiyun District, Guangzhou, Guangdong, P.R. China.,Department of Laboratory, The Sixth Affiliated Hospital of Kunming Medical University, Yuxi City, Yunnan, P.R. China
| | - Shiyan Nian
- Intensive Care Unit, People's Hospital of Yuxi City, Yuxi City, Yunnan, P.R. China
| | - Shu Zhang
- Department of Laboratory, The Sixth Affiliated Hospital of Kunming Medical University, Yuxi City, Yunnan, P.R. China
| | - Wenbo Xu
- Department of Laboratory, People's Hospital of Yuxi City, Yuxi City, Yunnan, P.R. China
| | - Xingfeng Zhang
- Department of Laboratory, People's Hospital of Yuxi City, Yuxi City, Yunnan, P.R. China
| | - Dan Ye
- Department of Laboratory, People's Hospital of Yuxi City, Yuxi City, Yunnan, P.R. China
| | - Lei Zheng
- Department of Laboratory Medicine, Nanfang Hospital, Southern Medical University, Baiyun District, Guangzhou, Guangdong, P.R. China
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17
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Fawzy MS, Abu AlSel BT. Assessment of Vitamin D-Binding Protein and Early Prediction of Nephropathy in Type 2 Saudi Diabetic Patients. J Diabetes Res 2018; 2018:8517929. [PMID: 29850609 PMCID: PMC5903345 DOI: 10.1155/2018/8517929] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 02/04/2018] [Indexed: 12/20/2022] Open
Abstract
Early detection of diabetic nephropathy (DN) represents a great challenge in an attempt to reduce the burden of chronic kidney diseases in diabetic patients. This study aimed to investigate the potential early prediction role of urinary vitamin D-binding protein (uVDBP) for the diagnosis of DN and to examine the possible correlation to serum VDBP, high-sensitivity C-reactive protein (hs-CRP), and insulin resistance in these patients. Serum and urine samples were obtained from 40 healthy volunteers and 120 patients with type 2 diabetes divided into 3 groups: normoalbuminuria, microalbuminuria, and macroalbuminuria (urinary albumin excretion rate < 30, 30-300, and >300 μg/mg, resp.); n = 40/group. Serum and urinary VDBP levels were quantified by ELISA. Insulin resistance has been assessed by homeostasis model assessment index (HOMAI). Correction for urine creatinine concentration was applied for urinary quantitative measurements. uVDBP levels were significantly elevated in micro- and macroalbuminuria patient groups compared with those of the normoalbuminuria patient group and controls (820.4 ± 402.8 and 1458.1 ± 210.0 compared with 193.1 ± 141.0 and 127.7 ± 21.9 ng/mg, resp.) (P < 0.001). There was significant correlation between serum and urinary levels of VDBP in total patient group. Receiver operating characteristic analysis of uVDBP levels showed optimum cut-off value of 216.0 ng/mg corresponding to 98.8% sensitivity and 80.0% specificity and an area under the curve of 0.973 to discriminate the normoalbuminuria from the microalbuminuria groups. In multivariate analysis, ordination plot showed obvious demarcation between the study groups caused by the higher levels of uVDBP and albumin/creatinine ratio among other variables. The study findings suggested a possible clinical application of uVDPB as an early and a good marker for the detection of early renal disease in type 2 DM Saudi patients. Large-scale validation studies are warranted to confirm the results before including uVDBP with the available list of other conventional biomarkers.
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Affiliation(s)
- Manal S. Fawzy
- Department of Biochemistry, Faculty of Medicine, Northern Border University, Arar, Saudi Arabia
- Department of Medical Biochemistry, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Baraah T. Abu AlSel
- Department of Microbiology, Faculty of Medicine, Northern Border University, Arar, Saudi Arabia
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Prognostic impact of baseline urinary albumin excretion rate in patients with resistant hypertension: a prospective cohort study. J Hum Hypertens 2017; 32:139-149. [DOI: 10.1038/s41371-017-0013-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 10/01/2017] [Accepted: 10/03/2017] [Indexed: 11/09/2022]
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19
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Pais R, Bourron O. Fatty liver and renal function impairment - Time for awareness? J Hepatol 2017; 68:S0168-8278(17)32395-4. [PMID: 29107153 DOI: 10.1016/j.jhep.2017.10.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 10/20/2017] [Accepted: 10/24/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Raluca Pais
- Service Hépatogastroentérologie, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière - Université Pierre et Marie Curie, UMR_S 938, INSERM - CDR Saint Antoine, Paris, France; Institute of Cardiometabolism and Nutrition (ICAN), Paris, France.
| | - Olivier Bourron
- Institute of Cardiometabolism and Nutrition (ICAN), Paris, France; Service d'Endocrinologie, Diabétologie et Nutrition, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière - Université Pierre et Marie Curie, INSERM UMR_S 1138 Centre de recherche des Cordeliers, Paris, France
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20
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Wang YQ, Wang CF, Zhu L, Yuan H, Wu LX, Chen ZH. Ideal cardiovascular health and the subclinical impairments of cardiovascular diseases: a cross-sectional study in central south China. BMC Cardiovasc Disord 2017; 17:269. [PMID: 29047374 PMCID: PMC5648483 DOI: 10.1186/s12872-017-0697-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 10/10/2017] [Indexed: 01/13/2023] Open
Abstract
Background Ideal cardiovascular health (CVH) is related to a low cardiovascular disease risk profile. This study aimed to investigate CVH metrics with both the biomarkers and markers of subclinical impairments of cardiovascular diseases (CVDs) in subjects from central south China. Methods The ideal CVH score (non-smoking status; ideal body mass index; regular physical activity; healthy diet; and an optimal serum cholesterol, blood pressure, and glucose profile; 1 point for each; total score: 0–7) was collected from 3009 participants without a history of CVDs. Subclinical biomarkers were assessed using C-reactive protein, homocysteine, and microalbuminuria. The presence of subclinical disease markers was defined as having at least one of the following: increased carotid intima-media thickness, carotid plaque, left ventricular hypertrophy, left ventricular systolic dysfunction, or a reduced ankle-brachial index. The association of biomarkers and markers with the CVH score was evaluated using multivariate logistic regression and linear regression analyses. Results Only 0.2% of the study participants met all 7 ideal CVH metrics (CVH score = 7). Compared to the female participants, the male participants had poorer CVH profiles and a higher incidence of subclinical lesions (P < 0.05). In the fully adjusted models, per 1-unit increase in the CVH score was inversely associated with the biomarker levels (β = -0.092 – -0.224, P < 0.05 for all) and the odds of the presence of markers (odds ratio, 0.808; 95% confidence interval, 0.755–0.865). Similar relationships were observed in the gender subgroups and were stronger in the females. Conclusion A clear inverse association was observed between the biomarkers or markers of subclinical impairments and the CVH score in a central south Chinese population, implying the importance of ideal CVH for the primordial prevention of CVDs. Electronic supplementary material The online version of this article (10.1186/s12872-017-0697-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ya-Qin Wang
- Department of Health Management Centre, the Third Xiangya Hospital, Central South University, Tongzipo Road 138, Changsha, Hunan Province, 410013, China
| | - Chang-Fa Wang
- Department of General Surgery, the Third Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Ling Zhu
- Department of Health Management Centre, the Third Xiangya Hospital, Central South University, Tongzipo Road 138, Changsha, Hunan Province, 410013, China
| | - Hong Yuan
- Department of Clinical Pharmacology Centre, the Third Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Liu-Xin Wu
- Zhongguancun Xinzhiyuan Health Management Institute, Beijing, China
| | - Zhi-Heng Chen
- Department of Health Management Centre, the Third Xiangya Hospital, Central South University, Tongzipo Road 138, Changsha, Hunan Province, 410013, China.
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Long-term changes in albuminuria: underlying causes and future mortality risk in a 20-year prospective cohort: the Nord-Trøndelag Health (HUNT) Study. J Hypertens 2017; 34:2081-9. [PMID: 27442788 DOI: 10.1097/hjh.0000000000001035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Knowledge on how changing risk factors influence the progression of albuminuria over time is still limited. Furthermore, large population-based cohorts are needed to study the association between albuminuria change and mortality risk in nondiabetic study participants. METHODS We evaluated changes of albuminuria in 6282 nondiabetic individuals from the Norwegian population-based Nord-Trøndelag Health study. Using three albumin/creatinine ratios (ACR), we studied the influence of cardiovascular risk factors on ACR change from baseline to follow-up 11 years later. We evaluated the next 8-year mortality risk by using flexible parametric methods to identify nonlinear main effects and their two-way interactions. RESULTS Mean albuminuria increased significantly over 11 years (1.82-3.02 mg/mmol, P < 0.0001), but two-thirds of individuals had stable levels (ΔACR -1.40 to 1.40 mg/mmol). Higher age, ACR, and SBP as well as smoking and lower glomerular filtration rate at baseline were associated with increasing albuminuria. Study participants in the upper quartile of the increasing group had mean adjusted hazard ratio 1.31 (P = 0.004) for all-cause mortality compared with those with stable ACR. Those with decreasing ACR also had increased mortality, but the risk was strongly attenuated when adjusting for comorbidity. It also decreased the first 3 years before increasing. There was a strong interaction between baseline ACR and ΔACR. Increasing albuminuria had strongest effect on mortality in study participants with moderately increased baseline values. CONCLUSION Both increasing and decreasing albuminuria are significant independent predictors of mortality in nondiabetic individuals, but must be interpreted in light of baseline values. Cutoffs and clinical usefulness in nondiabetic study participants should be further investigated.
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Campion CG, Sanchez-Ferras O, Batchu SN. Potential Role of Serum and Urinary Biomarkers in Diagnosis and Prognosis of Diabetic Nephropathy. Can J Kidney Health Dis 2017; 4:2054358117705371. [PMID: 28616250 PMCID: PMC5461910 DOI: 10.1177/2054358117705371] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 02/17/2017] [Indexed: 12/11/2022] Open
Abstract
PURPOSE OF REVIEW Diabetic nephropathy (DN) is a progressive kidney disease caused by alterations in kidney architecture and function, and constitutes one of the leading causes of end-stage renal disease (ESRD). The purpose of this review is to summarize the state of the art of the DN-biomarker field with a focus on the new strategies that enhance the sensitivity of biomarkers to predict patients who will develop DN or are at risk of progressing to ESRD. OBJECTIVE In this review, we provide a description of the pathophysiology of DN and propose a panel of novel putative biomarkers associated with DN pathophysiology that have been increasingly investigated for diagnosis, to predict disease progression or to provide efficient personal treatment. METHODS We performed a review of the literature with PubMed and Google Scholar to collect baseline data about the pathophysiology of DN and biomarkers associated. We focused our research on new and emerging biomarkers of DN. KEY FINDINGS In this review, we summarized the critical signaling pathways and biological processes involved in DN and highlighted the pathogenic mediators of this disease. We next proposed a large review of the major advances that have been made in identifying new biomarkers which are more sensitive and reliable compared with currently used biomarkers. This includes information about emergent biomarkers such as functional noncoding RNAs, microRNAs, long noncoding RNAs, exosomes, and microparticles. LIMITATIONS Despite intensive strategies and constant investigation, no current single treatment has been able to reverse or at least mitigate the progression of DN, or reduce the morbidity and mortality associated with this disease. Major difficulties probably come from the renal disease being heterogeneous among the patients. IMPLICATIONS Expanding the proteomics screening, including oxidative stress and inflammatory markers, along with metabolomics approaches may further improve the prognostic value and help in identifying the patients with diabetes who are at high risk of developing kidney diseases.
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Affiliation(s)
- Carole G. Campion
- Centre de recherche, Centre Hospitalier de l’Université de Montréal (CRCHUM), Québec, Canada
| | - Oraly Sanchez-Ferras
- Department of Biochemistry, Goodman Cancer Research Centre, McGill University, Montreal, Québec, Canada
| | - Sri N. Batchu
- St. Michael’s Hospital, University of Toronto, Ontario, Canada
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Yazici R, Guney İ, Altintepe L, Yazici M. Does the serum uric acid level have any relation to arterial stiffness or blood pressure in adults with congenital renal agenesis and/or hypoplasia? Clin Exp Hypertens 2017; 39:145-149. [PMID: 28287880 DOI: 10.1080/10641963.2016.1210630] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The relationship between serum uric acid and arterial stiffness or blood pressure is not clear. The serum uric acid level and its association with cardiovascular risk is not well known in patients with reduced renal mass. We aimed to investigate the relation between serum uric acid levels and arterial stiffness and also blood pressure in patients with congenital renal agenesis and/or hypoplasia. MATERIAL AND METHODS In this single center, cross-sectional study, a total of 55 patients (39 (% 70.9) with unilateral small kidney and 16 (%29.1) with renal agenesis) were included. The median age was 35 (21-50) years. The study population was divided into tertiles of serum uric acid (according to 2.40-3.96, 3.97-5.10, and 5.11-9.80 mg/dl cut-off values of serum uric acid levels). Official and 24-h ambulatory non-invasive blood pressures of all patients were measured. The arterial stiffness was assessed by pulse wave velocity (PWV). RESULTS PWV values were increased from first to third tertile (5.5 ± 0.6, 5.7 ± 0.8, 6.1 ± 0.7, respectively), but this gradual increase between tertiles did not reach significance. Linear regression analyses showed a positive correlation between serum uric acid levels and PWV (β = 0.40, p = 0.010), but no correlation was found between uric acid and daytime systolic blood pressure (β = 0.24, p = 0.345). CONCLUSION In congenital renal agenesis/hypoplasia, the serum uric acid level was positively correlated with arterial stiffness, but there was no correlation with blood pressure.
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Affiliation(s)
- Raziye Yazici
- a Konya Education and Research Hospital , Department of Nephrology , Konya , Turkey
| | - İbrahim Guney
- a Konya Education and Research Hospital , Department of Nephrology , Konya , Turkey
| | - Lutfullah Altintepe
- a Konya Education and Research Hospital , Department of Nephrology , Konya , Turkey
| | - Mehmet Yazici
- b Necmettin Erbakan University , Meram Medical School, Department of Cardiology , Konya , Turkey
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Basak T, Tanwar VS, Bhardwaj G, Bhardwaj N, Ahmad S, Garg G, V S, Karthikeyan G, Seth S, Sengupta S. Plasma proteomic analysis of stable coronary artery disease indicates impairment of reverse cholesterol pathway. Sci Rep 2016; 6:28042. [PMID: 27350024 PMCID: PMC4923873 DOI: 10.1038/srep28042] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 05/26/2016] [Indexed: 11/19/2022] Open
Abstract
Coronary artery disease (CAD) is one of the largest causes of death worldwide yet the traditional risk factors, although useful in identifying people at high risk, lack the desired predictive accuracy. Techniques like quantitative plasma proteomics holds immense potential to identify newer markers and this study (conducted in three phases) was aimed to identify differentially expressed proteins in stable CAD patients. In the first (discovery) phase, plasma from CAD cases (angiographically proven) and controls were subjected to iTRAQ based proteomic analysis. Proteins found to be differentially expressed were then validated in the second and third (verification and validation) phases in larger number of (n = 546) samples. After multivariate logistic regression adjusting for confounding factors (age, diet, etc.), four proteins involved in the reverse cholesterol pathway (Apo A1, ApoA4, Apo C1 and albumin) along with diabetes and hypertension were found to be significantly associated with CAD and could account for approximately 88% of the cases as revealed by ROC analysis. The maximum odds ratio was found to be 6.70 for albumin (p < 0.0001), followed by Apo AI (5.07, p < 0.0001), Apo CI (4.03, p = 0.001), and Apo AIV (2.63, p = 0.003). Down-regulation of apolipoproteins and albumin implicates the impairment of reverse cholesterol pathway in CAD.
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Affiliation(s)
- Trayambak Basak
- Genomics and Molecular Medicine Unit, CSIR-Institute of Genomics and Integrative Biology, New Delhi, India.,Academy of Scientific &Innovative Research, New Delhi, India
| | - Vinay Singh Tanwar
- Genomics and Molecular Medicine Unit, CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
| | - Gourav Bhardwaj
- Genomics and Molecular Medicine Unit, CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
| | - Nitin Bhardwaj
- Genomics and Molecular Medicine Unit, CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
| | - Shadab Ahmad
- Genomics and Molecular Medicine Unit, CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
| | - Gaurav Garg
- Genomics and Molecular Medicine Unit, CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
| | - Sreenivas V
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Ganesan Karthikeyan
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Seth
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Shantanu Sengupta
- Genomics and Molecular Medicine Unit, CSIR-Institute of Genomics and Integrative Biology, New Delhi, India.,Academy of Scientific &Innovative Research, New Delhi, India
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Khoundabi B, Kazemnejad A, Mansourian M, Faghihimani E. Factors Associated With Serum Albumin in Diabetes Mellitus Type 2 With Microalbuminuria Using Non-Normal Mixed Models: A Prospective Cohort Study. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e20671. [PMID: 26889385 PMCID: PMC4752729 DOI: 10.5812/ircmj.20671] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 07/06/2014] [Accepted: 08/05/2014] [Indexed: 01/08/2023]
Abstract
Background: The globally increasing epidemic of diabetes will lead to serious problems including diabetic nephropathy and kidney diseases in near future. The first clinical diagnosable stage in a diabetic kidney disease is microalbuminuria (urinary albumin excretion of 30 - 300 g/24 hours). Objectives: This prospective cohort study investigated the risk factors of microalbuminuria in patients with type 2 diabetes who had been registered in endocrine and metabolism research center in Isfahan city, Iran. Patients and Methods: This prospective cohort study was performed on 90 diabetic type 2 patients with microalbuminuria, who were selected according to the consecutive sample selection method during 6 years. Data were collected through regular and systematic measurements of serum albumin as the response variable and body mass index, systolic and diastolic blood pressure, the duration of diabetes, glycosylated hemoglobin (HbA1c), total cholesterol, triglyceride (TG), fasting blood sugar (FBS), low-density lipoprotein (LDL), and high-density lipoprotein (HDL) as the related factors. Non-normal mixed models were used to investigate the impact of effective factors on the amount of excreted serum albumin. Results: According to the deviance information criterion (DIC = 56.2), the non-normal mixed effects model with the skewed t distribution had a best fit and indicated that HbA1c, HDL and total cholesterol had a significant effect on the amount of albumin in urine (P < 0.05). Conclusions: Using nonnormal mixed models may lead to the best results as compared to common normality assumption.
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Affiliation(s)
- Batoul Khoundabi
- Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, IR Iran
| | - Anoshirvan Kazemnejad
- Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, IR Iran
- Corresponding Author: Anoshirvan Kazemnejad, Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, IR Iran. Tel: +98-2182883875, Fax: +98-2182884524, E-mail:
| | - Marjan Mansourian
- Department of Epidemiology and Biostatistics, School of Public Health, Isfahan University of Medical Sciences, Isfahan, IR Iran
| | - Elham Faghihimani
- Department of Internal Medicine, Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, IR Iran
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Harbaoui B, Courand PY, Defforges A, Khettab F, Milon H, Girerd N, Lantelme P. Cumulative Effects of Several Target Organ Damages in Risk Assessment in Hypertension. Am J Hypertens 2016; 29:234-44. [PMID: 26112867 DOI: 10.1093/ajh/hpv098] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 06/02/2015] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The prognostic value of screening multiple target organ damages (TODs) in hypertensive subjects has not been extensively studied. We estimated the prognostic value of considering 3 TODs in estimating the 10-year survival in hypertensive subjects. METHODS At baseline 1,848 out of a cohort of 1,963 hypertensive patients had a previous cardiovascular disease (CVD) or assessments of 3 TODs: Modification in Diet in Renal Disease (MDRD) <60ml/min or albuminuria >300mg/day, Sokolow index >3.5 mV, and advanced hypertensive retinopathy (grades 3 and 4 of Keith-Wagener-Barker classification). The cohort was divided into 5 groups: 0 TOD (N = 978), 1 TOD (N = 308), 2 TODs (N = 94), 3 TODs (N = 30), and previous CVD (N = 438). RESULTS After 10 years of follow-up, we observed 418 deaths of which 254 from cardiovascular cause. The adjusted hazard ratios for the major cardiovascular risk factors showed a progressive risk associated with the number of TODs. For all-cause death, the hazard ratios [95% confidence intervals] vs. 0 TOD of the other 4 groups were 1.91 [1.39-2.63], 1.99 [1.28-3.10], 4.33 [2.42-7.72], and 3.09 [2.35-4.05], respectively. For cardiovascular death, the hazard ratios [95% confidence intervals] were of the same order of magnitude: 2.14 [1.38-3.32], 2.12 [1.15-3.89], 4.22 [1.83-9.72], and 4.24 [2.95-6.11], respectively. CONCLUSIONS Our results indicate that hypertensive patients with several TODs had a worst outcome. Thus, it seems important to screen for multiple TODs in hypertension; especially check for severe hypertensive retinopathy in patients with left ventricular hypertrophy (LVH) and renal damage.
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Affiliation(s)
- Brahim Harbaoui
- Cardiology Department, European Society of Hypertension Excellence Center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France; Université Lyon-1, Villeurbanne, France; Génomique Fonctionnelle de l'Hypertension Artérielle, Lyon, France
| | - Pierre-Yves Courand
- Cardiology Department, European Society of Hypertension Excellence Center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France; Université Lyon-1, Villeurbanne, France; Génomique Fonctionnelle de l'Hypertension Artérielle, Lyon, France;
| | - Alice Defforges
- Cardiology Department, European Society of Hypertension Excellence Center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Fouad Khettab
- Cardiology Department, European Society of Hypertension Excellence Center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Hugues Milon
- Cardiology Department, European Society of Hypertension Excellence Center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Nicolas Girerd
- Inserm, Centre D'investigations Cliniques 9501 & U1116, Université de Lorraine, Institut Lorrain du cœur et des Vaisseaux Louis-Mathieu, Vandœuvre-lès-Nancy, France
| | - Pierre Lantelme
- Cardiology Department, European Society of Hypertension Excellence Center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France; Université Lyon-1, Villeurbanne, France; Génomique Fonctionnelle de l'Hypertension Artérielle, Lyon, France; Cardiology Department, Hôpital Nord Ouest, Villefranche-sur-Saône, France
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Impact of Salt Intake on the Pathogenesis and Treatment of Hypertension. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 956:61-84. [DOI: 10.1007/5584_2016_147] [Citation(s) in RCA: 119] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Microalbuminuria is a late event in patients with hypertension: Do we need a lower threshold? J Saudi Heart Assoc 2015; 29:30-36. [PMID: 28127216 PMCID: PMC5247301 DOI: 10.1016/j.jsha.2015.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 11/16/2015] [Accepted: 12/16/2015] [Indexed: 01/19/2023] Open
Abstract
Background Microalbuminuria (MA) is a marker of vascular damage. However, many studies have observed an increased risk at lower levels of albuminuria than are currently used to define MA. Aim To verify early cardiovascular changes occurring before MA in hypertensive patients. Materials and methods One hundred and fifty hypertensive patients and 60 normotensive individuals were divided into normotensive individuals with normal left ventricular (LV) geometry (Group I), hypertensive patients with normal LV geometry (Group II), and hypertensive patients with abnormal LV geometry (Group III). The LV mass index, ambulatory arterial stiffness index, flow-mediated dilatation of the brachial artery, and intima-media thickness (IMT) of the common carotid were assessed. Urinary albumin/creatinine ratio was determined using a morning spot-urine sample. Results Compared with Group I, ambulatory arterial stiffness index and IMT were significantly increased and flow-mediated dilatation was significantly decreased in Group II; however, MA did not differ between both groups. These changes were augmented when Group III was compared with Group II. MA significantly increased in Group III compared with Group II. Receiver operating characteristic analysis revealed that MA, with a cut-off value of 19.25 mg/g, predicted increased IMT, and abnormal LV geometry in a statistically significant manner. Conclusion Many vascular changes, in the form of increased IMT, reduced vasodilator capacity, and increased arterial stiffness, preceded MA and any change in LV geometry. The results presented here strengthen the usefulness of adopting a lower cut-off to define MA.
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Uric Acid Levels in Normotensive Children of Hypertensive Parents. Int J Chronic Dis 2015; 2015:747082. [PMID: 26464873 PMCID: PMC4590931 DOI: 10.1155/2015/747082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 08/06/2015] [Indexed: 01/22/2023] Open
Abstract
This study evaluated uric acid concentrations in normotensive children of parents with hypertension. Eighty normotensive children from families with and without a history of essential hypertension were included. Concentrations of lipid parameters and uric acid were compared. Demographic and anthropometric characteristics were similar in the groups. Systolic and diastolic blood pressure were higher in the normotensive children of parents with hypertension without statistically significant difference (P > 0.05). Uric acid concentrations were higher in the normotensive children of parents with hypertension (4.61 versus 3.57 mg/dL, P < 0.01). Total cholesterol and triglyceride concentrations were similar in the two groups. Systolic and diastolic blood pressure were significantly higher in control children aged >10 years (P < 0.01). Uric acid levels were significantly higher in all children with more pronounced difference after age 10 of years (P < 0.001). Positive correlations were found between the level of serum uric acid and age, body weight, body mass index, and systolic and diastolic blood pressure in the normotensive children of parents. The higher uric acid levels in the normotensive children of hypertensive parents suggest that uric acid may be a predeterminant of hypertension. Monitoring of uric acid levels in these children may allow for prevention or earlier treatment of future hypertension.
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Feng L, Zhang C, Nian S, Hao Y, Xu W, Zhang X, Zhang J, Li L. Screening for suspected coronary heart disease in patients, using integrated serum biochemical indices. J Epidemiol Community Health 2015; 70:195-201. [PMID: 26408658 PMCID: PMC4752617 DOI: 10.1136/jech-2015-206357] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Accepted: 08/25/2015] [Indexed: 11/11/2022]
Abstract
Background Many serum biochemical indices have been found to be associated with coronary heart disease (CHD); however, few studies have evaluated the value on screening CHD of the integrated serum biochemical indices. Methods In this study, 627 healthy controls and 1049 patients with CHD were recruited to develop CHD screening models for males and females using unconditional logistic regression. The performance of the screening models was evaluated by areas under the receiver operating characteristic (ROC) curves (AUCs), and externally validated in another population comprised of 190 healthy controls and 246 patients with CHD. Results Backward stepwise variable selection showed that increasing age, total cholesterol (TC), logarithm-transformed homocysteine (lnHCY), logarithm-transformed γ-glutamyl transpeptidase (lnGGT), and decreasing uric acid, logarithm-transformed triglyceride, apolipoprotein A (apoA) and apolipoprotein B (apoB), increased the detection of CHD in males. In comparison, increasing age, TC, lnHCY, lnGGT and high-density lipoprotein cholesterol versus low-density lipoprotein cholesterol, and decreasing apoA, apoB, logarithm transformed lipoprotein (A) and logarithm transformed total bilirubin, increased the detection of CHD in females. The AUCs for the screening models for males and females were 0.958 (95% CI 0.946 to 0.969) and 0.986 (95% CI 0.977 to 0.994), respectively. The performance of the screening models was further evaluated in external validation samples, the AUCs for males and females were 0.907 and 0.992, respectively. Conclusions Our study suggests that integrated serum biochemical indices may be used to screen for suspected CHD in participants.
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Affiliation(s)
- Lei Feng
- Department of Laboratory, People's Hospital of Yuxi City, Yuxi, Yunnan Province, China
| | - Chunfang Zhang
- Department of Clinical Epidemiology & Biostatistics, Peking University People's Hospital, Beijing, China
| | - Shiyan Nian
- Intensive Care Unit, People's Hospital of Yuxi City, Yuxi, Yunnan Province, China
| | - Yinglu Hao
- Department of Cardiology, People's Hospital of Yuxi City, Yuxi, Yunnan Province, China
| | - Wenbo Xu
- Department of Laboratory, People's Hospital of Yuxi City, Yuxi, Yunnan Province, China
| | - Xingfeng Zhang
- Department of Laboratory, People's Hospital of Yuxi City, Yuxi, Yunnan Province, China
| | - Jun Zhang
- Department of the First General Surgery, People's Hospital of Yuxi City, Yuxi, Yunnan Province, China
| | - Li Li
- Department of the Second General Surgery, People's Hospital of Yuxi City, Yuxi, Yunnan Province, China
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Abstract
Patients with resistant hypertension belong to a very high cardiovascular risk group and have a high prevalence of target organ damage. Microalbuminuria and low estimated glomerular filtration rate are associated with resistant hypertension, and could be a cause and/or complication of hypertension. In this review, we explore the relationship between these 2 markers of kidney disease and the prevalence of resistant hypertension. We identified different phenotypes of resistant hypertension that associate with microalbuminuria and/or low estimated glomerular filtration rate. These phenotypes suggest that high sympathetic activity associated with fluid overload and endothelial dysfunction may contribute differently to the development of resistant hypertension.
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Mulè G, Calcaterra I, Costanzo M, Morreale M, D'Ignoto F, Castiglia A, Geraci G, Rabbiolo G, Vaccaro F, Cottone S. Average real variability of 24-h systolic blood pressure is associated with microalbuminuria in patients with primary hypertension. J Hum Hypertens 2015; 30:164-70. [DOI: 10.1038/jhh.2015.66] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 05/04/2015] [Accepted: 05/19/2015] [Indexed: 11/09/2022]
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Yang Y, Zhang S, Lu B, Gong W, Dong X, Song X, Zhao W, Cui J, Liu Y, Hu R. Predicting diabetic nephropathy by serum proteomic profiling in patients with type 2 diabetes. Wien Klin Wochenschr 2015; 127:669-74. [DOI: 10.1007/s00508-014-0679-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 11/08/2014] [Indexed: 11/29/2022]
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Mulè G, Calcaterra I, Costanzo M, Geraci G, Guarino L, Foraci AC, Vario MG, Cerasola G, Cottone S. Relationship Between Short-Term Blood Pressure Variability and Subclinical Renal Damage in Essential Hypertensive Patients. J Clin Hypertens (Greenwich) 2015; 17:473-80. [PMID: 25808042 DOI: 10.1111/jch.12534] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 02/02/2015] [Accepted: 02/04/2015] [Indexed: 12/14/2022]
Abstract
The authors aimed to analyze the relationship between subclinical renal damage, defined as the presence of microalbuminuria or an estimated glomerular filtration rate (eGFR) between 30 mL/min/1.73 m(2) and 60 mL/min/1.73 m(2) and short-term blood pressure (BP) variability, assessed as average real variability (ARV), weighted standard deviation (SD) of 24-hour BP, and SD of daytime and nighttime BP. A total of 328 hypertensive patients underwent 24-hour ambulatory BP monitoring, 24-hour albumin excretion rate determination, and eGFR calculation using the Chronic Kidney Disease Epidemiology Collaboration equation. ARV of 24-hour systolic BP (SBP) was significantly higher in patients with subclinical renal damage (P=.001). This association held (P=.04) after adjustment for potential confounders. In patients with microalbuminuria, ARV of 24-hour SBP, weighted SD of 24-hour SBP, and SD of daytime SBP were also independently and inversely related to eGFR. These results seem to suggest that in essential hypertension, short-term BP variability is independently associated with early renal abnormalities.
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Affiliation(s)
- Giuseppe Mulè
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - Ilenia Calcaterra
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - Miriam Costanzo
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - Giulio Geraci
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - Laura Guarino
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - Anna C Foraci
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - Maria G Vario
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - Giovanni Cerasola
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - Santina Cottone
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
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Kehler DS, Stammers AN, Susser SE, Hamm NC, Kimber DE, Hlynsky MW, Duhamel TA. Cardiovascular complications of type 2 diabetes in youth. Biochem Cell Biol 2014; 93:496-510. [PMID: 25629355 DOI: 10.1139/bcb-2014-0118] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The prevalence of type 2 diabetes mellitus (T2DM) in youth has increased dramatically over the past decades. The literature also suggests that the progression from an impaired glucose tolerance state to established T2DM is more rapid in youth, compared to adults. The presence of significant cardiovascular complications in youth with T2DM, including cardiac, macrovascular, and microvascular remodeling, is another major issue in this younger cohort and poses a significant threat to the healthcare system. However, this issue is only now emerging as a major public health concern, with few data to support optimal treatment targets and strategies to reduce cardiovascular disease (CVD) risk in youth with T2DM. Accordingly, the purpose of this minireview is to better understand the cardiovascular complications in youth with T2DM. We briefly describe the pathophysiology from youth studies, including oxidative stress, inflammation, renin-angiotensin aldosterone system, and epigenetics, which link T2DM and CVD. We also describe the literature concerning the early signs of CVD in youth and potential treatment options to reduce cardiovascular risk.
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Affiliation(s)
- D Scott Kehler
- a Health, Leisure and Human Performance Research Institute, Faculty of Kinesiology and Recreation Management, University Of Manitoba.,b Institute of Cardiovascular Sciences, St. Boniface Hospital Research Centre
| | - Andrew N Stammers
- a Health, Leisure and Human Performance Research Institute, Faculty of Kinesiology and Recreation Management, University Of Manitoba.,b Institute of Cardiovascular Sciences, St. Boniface Hospital Research Centre
| | - Shanel E Susser
- b Institute of Cardiovascular Sciences, St. Boniface Hospital Research Centre.,c Department of Physiology, University of Manitoba
| | - Naomi C Hamm
- a Health, Leisure and Human Performance Research Institute, Faculty of Kinesiology and Recreation Management, University Of Manitoba.,b Institute of Cardiovascular Sciences, St. Boniface Hospital Research Centre
| | - Dustin E Kimber
- a Health, Leisure and Human Performance Research Institute, Faculty of Kinesiology and Recreation Management, University Of Manitoba.,b Institute of Cardiovascular Sciences, St. Boniface Hospital Research Centre
| | - Michael W Hlynsky
- a Health, Leisure and Human Performance Research Institute, Faculty of Kinesiology and Recreation Management, University Of Manitoba.,b Institute of Cardiovascular Sciences, St. Boniface Hospital Research Centre
| | - Todd A Duhamel
- a Health, Leisure and Human Performance Research Institute, Faculty of Kinesiology and Recreation Management, University Of Manitoba.,b Institute of Cardiovascular Sciences, St. Boniface Hospital Research Centre.,c Department of Physiology, University of Manitoba.,d Manitoba Institute of Child Health, Winnipeg, Manitoba, Canada
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Yoon SJ, Kim DH, Nam GE, Yoon YJ, Han KD, Jung DW, Park SW, Kim YE, Lee SH, Lee SS, Kim YH. Prevalence and control of hypertension and albuminuria in South Korea: focus on obesity and abdominal obesity in the Korean National Health and Nutrition Examination Survey, 2011-2012. PLoS One 2014; 9:e111179. [PMID: 25360593 PMCID: PMC4215993 DOI: 10.1371/journal.pone.0111179] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 09/24/2014] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Albuminuria is associated with cardiovascular disease, and the relationship between albuminuria and hypertension is well established in many studies. So the control of hypertension is critical for decreasing cardiovascular events and albuminuria. Obesity and abdominal obesity are also associated with hypertension and albuminuria. Therefore, we analyzed the relationship between albuminuria and the prevalence and control of hypertension in the general Korean population according to obesity status. METHODS We analyzed data from the 2011-2012 Korea National Health and Nutrition Examination Survey, and 9,519 subjects were included. Subjects were divided into four groups: non-obese/normal waist circumference, non-obese/high waist circumference, obese/normal waist circumference, and obese/high waist circumference. RESULTS Systolic blood pressure and diastolic blood pressure were positively associated with albumin-creatinine ratio in all groups (all p values <0.005). Non-obese/normal waist circumference group were more likely to have hypertension (odds ratios [95% confidential intervals (CIs)] were 3.20 [2.21-4.63] in microalbuminuria level and 3.09 [1.05-9.14] in macroalbuminuria level), and less likely to have controlled hypertension (odds ratios <1 for both albuminuria levels) after adjusting for all covariates. Obese/normal waist circumference group were also more likely to have hypertension (odds ratio [95% CI] were 3.10 [1.56-6.15] in microalbuminuria level and 21.75 [3.66-129.04] in macroalbuminuria level), and less likely to have controlled hypertension in macroalbuminuria level (odds ratio [95% CI], 0.04 [0.01-0.15]). CONCLUSIONS Non-obese and normal waist circumference subjects have an increased prevalence and decreased control of hypertension in microalbuminuria and macroalbuminuria levels. Screening for albuminuria may provide helpful information about hypertension and blood pressure control, particularly in the non-obese and normal waist circumference subjects.
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Affiliation(s)
- Su-Jung Yoon
- Department of Family Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Do-Hoon Kim
- Department of Family Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Ga-Eun Nam
- Department of Family Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Yeo-Joon Yoon
- Department of Family Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Kyung-Do Han
- Department of Medical Statistics, Catholic University College of Medicine, Seoul, South Korea
| | - Dong-Wook Jung
- Department of Family Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Sang-Woon Park
- Department of Family Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Young-Eun Kim
- Department of Family Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Sung-Ho Lee
- Department of Family Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Sang-Su Lee
- Department of Family Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Yang-Hyun Kim
- Department of Family Medicine, Korea University College of Medicine, Seoul, South Korea
- * E-mail:
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Yan L, Ma J, Guo X, Tang J, Zhang J, Lu Z, Wang H, Cai X, Wang L. Urinary albumin excretion and prevalence of microalbuminuria in a general Chinese population: a cross-sectional study. BMC Nephrol 2014; 15:165. [PMID: 25308236 PMCID: PMC4209030 DOI: 10.1186/1471-2369-15-165] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 10/08/2014] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Microalbuminuria has been shown to be a risk factor for cardiovascular and renal disease in patients with hypertension and diabetes as well as in the general population. Urinary albumin excretion over 24 h is considered a 'gold standard' to detect microalbuminuria. Few studies have used 24-h urinary albumin excretion to analyze the prevalence of and related factors for microalbuminuira in a general Chinese population. METHODS This study included 1980 adults aged 18-69 years from the Shandong-Ministry of Health Action on Salt and Hypertension (SMASH) Project 2011 survey. Blood pressure, height, weight and waist circumference were measured, and a venous blood and timed 24-h urine samples were collected from each participant. Linear and logistic regression analyses were used to test associations between established cardiovascular risk factors and microalbuminuria. RESULTS The median (25th-75th percentile) of 24-h urinary albumin excretion was 6.1 mg/d (4.5-8.7 mg/d) for all adults, 6.0 mg/d (4.4-8.5 mg/d) for men and 6.2 mg/d (4.6-8.9 mg/d) for women. The overall prevalence of microalbuminuria was 4.1% (95% confidence interval [CI]: 3.2-5.0%), 3.7% (95% CI: 2.9-4.5%) for men and 4.6% (95% CI: 3.7-5.5%) for women. Microalbuminuria was present in 8.1% (95% CI: 6.9-9.3%) of individuals with hypertension, 11.4% (95% CI: 10.0-12.8%) of those with diabetes and 15.6% (95% CI: 14.0-17.2%) of those with both. Multiple logistic regression analysis indicated that systolic blood pressure (odds ratio [OR] 1.02; 95% CI: 1.01-1.03) and fasting blood glucose (OR 1.19; 95% CI: 1.05-1.35) were the independent risk factors for microalbuminuria. CONCLUSIONS Adults in the general population of Shandong Province have a moderate prevalence of microalbuminuria. Those with hypertension and diabetes are at high risk of having microalbuminuria, suggesting the need for screening and early intervention for microalbuminuria among these individuals.
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Affiliation(s)
- Liuxia Yan
- />National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 100050 China
| | - Jixiang Ma
- />National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 100050 China
| | - Xiaolei Guo
- />Academy of Preventive Medicine, Shandong University, Jinan, 250014 China
- />Shandong Center for Disease Control and Prevention, Jinan, 250014 China
| | - Junli Tang
- />Academy of Preventive Medicine, Shandong University, Jinan, 250014 China
- />Shandong Center for Disease Control and Prevention, Jinan, 250014 China
| | - Jiyu Zhang
- />Academy of Preventive Medicine, Shandong University, Jinan, 250014 China
- />Shandong Center for Disease Control and Prevention, Jinan, 250014 China
| | - Zilong Lu
- />Academy of Preventive Medicine, Shandong University, Jinan, 250014 China
- />Shandong Center for Disease Control and Prevention, Jinan, 250014 China
| | - Huicheng Wang
- />Chinese Center for Disease Control and Prevention, Beijing, 102206 China
| | - Xiaoning Cai
- />National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 100050 China
| | - Linhong Wang
- />National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 100050 China
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Mulè G, Calcaterra I, Nardi E, Cerasola G, Cottone S. Metabolic syndrome in hypertensive patients: An unholy alliance. World J Cardiol 2014; 6:890-907. [PMID: 25276291 PMCID: PMC4176799 DOI: 10.4330/wjc.v6.i9.890] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Revised: 05/13/2014] [Accepted: 07/18/2014] [Indexed: 02/06/2023] Open
Abstract
For many years, it has been recognized that hypertension tends to cluster with various anthropometric and metabolic abnormalities including abdominal obesity, elevated triglycerides, reduced high-density lipoprotein cholesterol, glucose intolerance, insulin resistance and hyperuricemia. This constellation of various conditions has been transformed from a pathophysiological concept to a clinical entity, which has been defined metabolic syndrome (MetS). The consequences of the MetS have been difficult to assess without commonly accepted criteria to diagnose it. For this reason, on 2009 the International Diabetes Federation, the American Heart Association and other scientific organizations proposed a unified MetS definition. The incidence of the MetS has been increasing worldwide in parallel with an increase in overweight and obesity. The epidemic proportion reached by the MetS represents a major public health challenge, because several lines of evidence showed that the MetS, even without type 2 diabetes, confers an increased risk of cardiovascular morbidity and mortality in different populations including also hypertensive patients. It is likely that the enhanced cardiovascular risk associated with MetS in patients with high blood pressure may be largely mediated through an increased prevalence of preclinical cardiovascular and renal changes, such as left ventricular hypertrophy, early carotid atherosclerosis, impaired aortic elasticity, hypertensive retinopathy and microalbuminuria. Indeed, many reports support this notion, showing that hypertensive patients with MetS exhibit, more often than those without it, these early signs of end organ damage, most of which are recognized as significant independent predictors of adverse cardiovascular outcomes.
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Din AH, Frew Q, Smailes ST, Dziewulski P. The utility of microalbuminuria measurements in pediatric burn injuries in critical care. J Crit Care 2014; 30:156-61. [PMID: 25307977 DOI: 10.1016/j.jcrc.2014.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Revised: 09/06/2014] [Accepted: 09/06/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Microalbuminuria, as measured by urinary albumin-creatinine ratios (ACRs), has been shown to be a marker of systemic inflammation and an indicator of the potential severity of trauma and critical illness. Severe pediatric burns represent the best model in which to investigate the clinical utility of microalbuminuria. This study aims to ascertain whether ACR measurements have any role in predicting the severity or the intensive care requirements in the critically unwell pediatric burn population. MATERIALS AND METHODS A retrospective observational study was undertaken within a regional burn center with a dedicated 8-bed burn intensive care unit (ICU). This looked at 8 years of consecutive pediatric burns requiring intensive care support-a total of 63 patients after exclusions. Daily urinary ACR measurements were acquired from all patients. RESULTS All patients had greater than or equal to 1 ACR measurement out with the reference range, and only 8% (5/63) presented to the ICU with a normal ACR. The median day for the peak ACR measurement was day 4. The relative lack of mortalities (3/63) precluded adequate correlations between ACR and outcomes. Peak and mean ACR values correlate well with length of ICU stay, and the peak ACR also correlates with total length of hospital stay and severity of burn injury as measured by total body surface area burnt and number of organ systems requiring support. No significant differences were found when the patients were stratified by age. The peak ACR measurement was found to be independently predictive of the length of the ICU stay. As such, we have created a predictive model to prove that an ACR that remains less than 12 mg/mmol is predicative of an ICU stay of less than or equal to 7 days. CONCLUSIONS The clinical utilities of ACR measurements are demonstrated by their correlation with the severity of injury, length of ICU stay, and requirements for multiple organ support. Albumin-creatinine ratios raised over certain thresholds highlight to the clinician the need for closer observation and the potential deterioration of patients.
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Affiliation(s)
- Asmat H Din
- St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, United Kingdom, CM1 7ET.
| | - Quentin Frew
- St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, United Kingdom, CM1 7ET
| | - Sarah T Smailes
- St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, United Kingdom, CM1 7ET
| | - Peter Dziewulski
- St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, United Kingdom, CM1 7ET
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Rear R, Meier P, Bell RM. Implications of Kidney Disease in the Cardiac Patient. Interv Cardiol Clin 2014; 3:317-331. [PMID: 28582216 DOI: 10.1016/j.iccl.2014.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Traditional cardiovascular risk factors, particularly hypertension and diabetes, are common in the disease processes of both renal and cardiac pathology. Unfortunately the coexistence of renal impairment is not an innocent bystander in cardiovascular disease; it disorder not only increases the prevalence and severity of cardiovascular disease, but also negatively affects prognostic outcomes and the safety and efficacy of cardiac interventions. This article discusses the role and impact of kidney disease in the cardiac patient in 3 key common cardiovascular processes: coronary artery disease, arrhythmia, and heart failure.
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Affiliation(s)
- Roger Rear
- General and Interventional Cardiology Department, The Heart Hospital, University College Hospitals NHS Trust, 16-18 Westmoreland Street, London, W1G 8PH, UK; Clinical Research Department, The Hatter Cardiovascular Institute, University College London, 37 Chenies Mews, London, WC1E 6HX, UK
| | - Pascal Meier
- General and Interventional Cardiology Department, The Heart Hospital, University College Hospitals NHS Trust, 16-18 Westmoreland Street, London, W1G 8PH, UK
| | - Robert M Bell
- General and Interventional Cardiology Department, The Heart Hospital, University College Hospitals NHS Trust, 16-18 Westmoreland Street, London, W1G 8PH, UK; Clinical Research Department, The Hatter Cardiovascular Institute, University College London, 37 Chenies Mews, London, WC1E 6HX, UK.
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Mulè G, Riccobene R, Castiglia A, D'Ignoto F, Ajello E, Geraci G, Guarino L, Nardi E, Vaccaro F, Cerasola G, Cottone S. Relationships between mild hyperuricaemia and aortic stiffness in untreated hypertensive patients. Nutr Metab Cardiovasc Dis 2014; 24:744-750. [PMID: 24675008 DOI: 10.1016/j.numecd.2014.01.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Revised: 01/02/2014] [Accepted: 01/08/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND AIMS Clinical studies exploring the relationship between serum uric acid (SUA) and arterial stiffness yielded conflicting results. Only in a few of these studies, arterial distensibility was examined by measuring aortic pulse wave velocity (PWV), which is considered the gold standard for evaluating arterial stiffness. In none of the previous investigations was the influence of SUA on aortic distensibility assessed, taking into account the effect of albuminuria. The purpose of our study was to comprehensively analyse the relationships between SUA and aortic PWV in a group of essential hypertensive patients. METHODS AND RESULTS We enrolled 222 untreated and uncomplicated hypertensive subjects (mean age: 44 ± 10 years; 60% males), without gout. In all patients, SUA and urinary albumin excretion rate (AER) were determined. Moreover, carotid-femoral (c-f) PWV was measured. C-f PWV was significantly higher in hypertensive patients belonging to the uppermost tertile of SUA distribution, compared to subjects of the lowest tertiles (10.9 ± 2.2 vs. 10 ± 1.8 vs. 9.9 ± 1.7 m s(-1); p = 0.001). In univariate analysis, SUA correlated with c-f PWV (r = 0.24; p < 0.001). This association disappeared when AER was added in a multiple regression model, including SUA, age, mean arterial pressure, gender, metabolic syndrome components and glomerular filtration rate. CONCLUSION The results of our study showed that, in essential hypertensive subjects, there is a positive relationship between mild hyperuricaemia and aortic stiffness. This association weakened after adjustment for covariates and lost statistical significance after further correction for albuminuria.
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Affiliation(s)
- G Mulè
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy.
| | - R Riccobene
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - A Castiglia
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - F D'Ignoto
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - E Ajello
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - G Geraci
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - L Guarino
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - E Nardi
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - F Vaccaro
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - G Cerasola
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - S Cottone
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
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Pedersen E, Jesudason DR, Clifton PM. High protein weight loss diets in obese subjects with type 2 diabetes mellitus. Nutr Metab Cardiovasc Dis 2014; 24:554-562. [PMID: 24374004 DOI: 10.1016/j.numecd.2013.11.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 11/07/2013] [Accepted: 11/23/2013] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIM Diets where carbohydrate has been partially exchanged for protein have shown beneficial changes in persons with type 2 diabetes but no studies have enrolled people with albuminuria. We aim to determine if a high protein to carbohydrate ratio (HPD) in an energy reduced diet has a beneficial effect on metabolic control and cardiovascular risk factors without negatively affecting renal function. METHOD AND RESULTS Adult, overweight participants with type 2 diabetes, with albuminuria (30-600 mg/24 h or an albumin-to-creatinine ratio of 3.0-60 mg/mmol), and estimated GFR of >40 ml/min/1.73 m(2) were enrolled. Participants were randomized to an HPD or an SPD. Protein:fat:carbohydrate ratio was 30:30:40% of energy for the HPD and 20:30:50% for the SPD. Main outcomes were renal function, weight loss, blood pressure, serum lipids and glycaemic control. We recruited 76 volunteers and 45 (35 men and 10 women) finished. There were no overall changes in renal function at 12 months and no significant differences in weight loss between groups (9.7 ± 2.9 kg and 6.6 ± 1.4 kg HPD and SPD group respectively; p = 0.32). Fasting blood glucose decreased significantly with no treatment effect. The decrease in HbA1c differed between treatments at 6 months (HPD -0.9 vs. SPD -0.3%; p = 0.039) but not at 12 months. HDL increased significantly with no treatment effects. There were no changes in LDL or blood pressure overall but DBP was lower in the HPD group (p = 0.024) at 12 months. CONCLUSION Weight loss improved overall metabolic control in this group of well controlled participants with type 2 diabetes regardless of diet composition.
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Affiliation(s)
- E Pedersen
- Commonwealth Scientific & Industrial Research Organisation (CSIRO), Australia; Clinical Research Excellence (CRE) in Nutritional Physiology, University of Adelaide, Discipline of Medicine, Australia
| | - D R Jesudason
- Commonwealth Scientific & Industrial Research Organisation (CSIRO), Australia; Clinical Research Excellence (CRE) in Nutritional Physiology, University of Adelaide, Discipline of Medicine, Australia
| | - P M Clifton
- Commonwealth Scientific & Industrial Research Organisation (CSIRO), Australia; University of South Australia, Australia; Clinical Research Excellence (CRE) in Nutritional Physiology, University of Adelaide, Discipline of Medicine, Australia.
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Yoon JH, Won JU, Ahn YS, Roh J. Poor lung function has inverse relationship with microalbuminuria, an early surrogate marker of kidney damage and atherosclerosis: the 5th Korea National Health and Nutrition Examination Survey. PLoS One 2014; 9:e94125. [PMID: 24718679 PMCID: PMC3981770 DOI: 10.1371/journal.pone.0094125] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 03/12/2014] [Indexed: 11/22/2022] Open
Abstract
Background Despite epidemiological evidences of relationship between poor lung function and atherosclerosis, the relationship between poor lung function and microalbuminuria (MAU), an early surrogate marker of both kidney damage and atherosclerosis, is not well understood. Hence, we plan to investigate the relationship between poor lung function and MAU using multivariate models to adjust for other atherogenic risk factors. Methods We used data from the 5th Korean National Health and Nutrition Examination Survey. Poor lung function is determined by spirometric measurement, primarily through estimation of the forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1). Declines in the percent predicted FVC (<80%) and in the FEV1/FVC ratio (<0.7) are defined as restrictive and obstructive patterns, respectively. Urine albumin to urine creatinine levels ratio (UACR) were measured in spot urine samples. MAU was defined as UACR >30 mg/g. Results Inverse relationship was observed between lung function and UACR. In an age-adjusted regression model, the regression coefficient (B) of 10% lower FVC was 11.09 in men (P = 0.002), which remained significant after adjustment for SBP, FBG, triglyceride level, BMI, smoking history, and heavy alcohol consumption (B = 7.52, P = 0.043). When the restrictive pattern was compared to the normal pattern, the odds ratios (OR) (95% confidence interval, 95%CI) for MAU were 1.90 (1.32–2.72) in men, after adjustment for age, hypertension, diabetes mellitus, triglyceride level, obesity, smoking history, physical activity, and heavy alcohol consumption. Conclusions Our study, the first investigation in Asia, demonstrated that the restrictive pattern is related to MAU in men. Furthermore, there was linear relationship between lower FVC and UACR. Thus, our current study suggests that poor lung function, particularly the restrictive pattern, is related to kidney damage as well as atherosclerosis.
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Affiliation(s)
- Jin-Ha Yoon
- The Institute for Occupational Health, Yonsei University College of Medicine, Seoul, Korea
- Department of Preventive Medicine and Public Health, Yonsei University College of Medicine, Seoul, Korea
- Graduate School of Public Health, Yonsei University College of Medicine, Seoul, Korea
| | - Jong-Uk Won
- The Institute for Occupational Health, Yonsei University College of Medicine, Seoul, Korea
- Department of Preventive Medicine and Public Health, Yonsei University College of Medicine, Seoul, Korea
- Graduate School of Public Health, Yonsei University College of Medicine, Seoul, Korea
| | - Yeon-Soon Ahn
- Department of Occupational and Environmental Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Jaehoon Roh
- The Institute for Occupational Health, Yonsei University College of Medicine, Seoul, Korea
- Department of Preventive Medicine and Public Health, Yonsei University College of Medicine, Seoul, Korea
- Graduate School of Public Health, Yonsei University College of Medicine, Seoul, Korea
- * E-mail:
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Impellizzeri D, Esposito E, Attley J, Cuzzocrea S. Targeting inflammation: new therapeutic approaches in chronic kidney disease (CKD). Pharmacol Res 2014; 81:91-102. [PMID: 24602801 DOI: 10.1016/j.phrs.2014.02.007] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Revised: 02/18/2014] [Accepted: 02/24/2014] [Indexed: 01/14/2023]
Abstract
Chronic inflammation and oxidative stress, features that are closely associated with nuclear factor (NF-κB) activation, play a key role in the development and progression of chronic kidney disease (CKD). Several animal models and clinical trials have clearly demonstrated the effectiveness of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) therapy to improve glomerular/tubulointerstitial damage, reduce proteinuria, and decrease CKD progression, but CKD treatment still represents a clinical challenge. Bardoxolone methyl, a first-in-class oral Nrf-2 (nuclear factor erythroid 2-related factor 2) agonist that until recently showed considerable potential for the management of a range of chronic diseases, had been shown to improve kidney function in patients with advanced diabetic nephropathy (DN) with few adverse events in a phase 2 trial, but a large phase 3 study in patients with diabetes and CKD was halted due to emerging toxicity and death in a number of patients. Instead, palmitoylethanolamide (PEA) a member of the fatty acid ethanolamine family, is a novel non-steroidal, kidney friendly anti-inflammatory and anti-fibrotic agent with a well-documented safety profile, that may represent a potential candidate in treating CKD probably by a combination of pharmacological properties, including some activity at the peroxisome proliferator activated receptor alpha (PPAR-α). The aim of this review is to discuss new therapeutic approaches for the treatment of CKD, with particular reference to the outcome of two therapies, bardoxolone methyl and PEA, to improve our understanding of which pharmacological properties are responsible for the anti-inflammatory effects necessary for the effective treatment of renal disease.
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Affiliation(s)
- Daniela Impellizzeri
- Department of Biological and Environmental Sciences, University of Messina, Viale Ferdinando Stagno D'Alcontres, Messina 31-98166, Italy
| | - Emanuela Esposito
- Department of Biological and Environmental Sciences, University of Messina, Viale Ferdinando Stagno D'Alcontres, Messina 31-98166, Italy
| | | | - Salvatore Cuzzocrea
- Department of Biological and Environmental Sciences, University of Messina, Viale Ferdinando Stagno D'Alcontres, Messina 31-98166, Italy; Manchester Biomedical Research Centre, Manchester Royal Infirmary, University of Manchester, United Kingdom.
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Viberti G, Karalliedde J. Commentary: the birth of microalbuminuria: a milestone in the history of medicine. Int J Epidemiol 2014; 43:18-20. [PMID: 24374830 DOI: 10.1093/ije/dyt256] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- Giancarlo Viberti
- Unit for Metabolic Medicine, Cardiovascular Division, King's College London School of Medicine, London, UK
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Hatlen G, Romundstad S, Hallan SI. The accuracy of predicting cardiovascular death based on one compared to several albuminuria values. Kidney Int 2013; 85:1421-8. [PMID: 24352157 DOI: 10.1038/ki.2013.500] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Revised: 09/20/2013] [Accepted: 10/03/2013] [Indexed: 11/09/2022]
Abstract
Albuminuria is a well-documented predictor of cardiovascular (CV) mortality. However, day-to-day variability is substantial, and there is no consensus on the number of urine samples required for risk prediction. To resolve this we followed 9158 adults from the population-based Nord-Trøndelag Health Study for 13 years (Second HUNT Study). The predictive performance of models for CV death based on Framingham variables plus 1 versus 3 albumin-creatinine ratio (ACR) was assessed in participants who provided 3 urine samples. There was no improvement in discrimination, calibration, or reclassification when using ACR as a continuous variable. Difference in Akaike information criterion indicated an uncertain improvement in overall fit for the model with the mean of 3 urine samples. Criterion analyses on dichotomized albuminuria information sustained 1 sample as sufficient for ACR levels down to 1.7 mg/mmol. At lower levels, models with 3 samples had a better overall fit. Likewise, in survival analyses, 1 sample was enough to show a significant association to CV mortality for ACR levels above 1.7 mg/mmol (adjusted hazard ratio 1.37; 95% CI 1.15-1.63). For lower ACR levels, 2 or 3 positive urine samples were needed for significance. Thus, multiple urine sampling did not improve CV death prediction when using ACR as a continuous variable. For cutoff ACR levels of 1.0 mg/mmol or less, additional urine samples were required, and associations were stronger with increasing number of samples.
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Affiliation(s)
- Gudrun Hatlen
- 1] Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway [2] Division of Nephrology, Department of Medicine, St Olav University Hospital, Trondheim, Norway
| | - Solfrid Romundstad
- 1] Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway [2] Department of Internal Medicine, Levanger Hospital, Health Trust Nord-Trøndelag, Levanger, Norway [3] HUNT Research Centre, Faculty of Medicine, Norwegian University of Science and Technology, Levanger, Norway
| | - Stein I Hallan
- 1] Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway [2] Division of Nephrology, Department of Medicine, St Olav University Hospital, Trondheim, Norway
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48
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Groop PH, Cooper ME, Perkovic V, Emser A, Woerle HJ, von Eynatten M. Linagliptin lowers albuminuria on top of recommended standard treatment in patients with type 2 diabetes and renal dysfunction. Diabetes Care 2013; 36:3460-8. [PMID: 24026560 PMCID: PMC3816860 DOI: 10.2337/dc13-0323] [Citation(s) in RCA: 217] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Preclinical data suggest that linagliptin, a dipeptidyl peptidase-4 inhibitor, may lower urinary albumin excretion. The ability of linagliptin to lower albuminuria on top of renin-angiotensin-aldosterone system (RAAS) inhibition in humans was analyzed by pooling data from four similarly designed, 24-week, randomized, double-blind, placebo-controlled, phase III trials. RESEARCH DESIGN AND METHODS A pooled analysis of four completed studies identified 217 subjects with type 2 diabetes and prevalent albuminuria (defined as a urinary albumin-to-creatinine ratio [UACR] of 30-3,000 mg/g creatinine) while receiving stable doses of RAAS inhibitors. Participants were randomized to either linagliptin 5 mg/day (n = 162) or placebo (n= 55). The primary end point was the percentage change in geometric mean UACR from baseline to week 24. RESULTS UACR at week 24 was reduced by 32% (95% CI -42 to -21; P < 0.05) with linagliptin compared with 6% (95% CI -27 to +23) with placebo, with a between-group difference of 28% (95% CI -47 to -2; P = 0.0357). The between-group difference in the change in HbA1c from baseline to week 24 was -0.61% (-6.7 mmol/mol) in favor of linagliptin (95% CI -0.88 to -0.34% [-9.6 to -3.7 mmol/mol]; P < 0.0001). The albuminuria-lowering effect of linagliptin, however, was not influenced by race or HbA1c and systolic blood pressure (SBP) values at baseline or after treatment. CONCLUSIONS Linagliptin administered in addition to stable RAAS inhibitors led to a significant reduction in albuminuria in patients with type 2 diabetes and renal dysfunction. This observation was independent of changes in glucose level or SBP. Further research to prospectively investigate the renal effects of linagliptin is underway.
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The Coronary Artery Disease and Renal Failure (CAD-REF) registry: trial design, methods, and aims. Am Heart J 2013; 166:449-56. [PMID: 24016493 DOI: 10.1016/j.ahj.2013.06.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Accepted: 06/02/2013] [Indexed: 12/25/2022]
Abstract
BACKGROUND During the past 10 years, chronic kidney disease (CKD) has been recognized as a major global health problem. Factors leading to decreased renal function are closely related to cardiovascular disease and vice versa. Cardiovascular morbidity and mortality are substantially increased in patients with CKD, even in those with only mild or moderate renal impairment. A better understanding of pathogenesis, risk factors, and genetic conditions is strongly required for more specific treatment strategies in CKD because until now, knowledge is very limited. METHODS The German CAD-REF registry is a prospective observational multicenter national registry. It aims at including >3,300 white patients with angiographically documented coronary artery disease (coronary artery disease [CAD]; ≥50% stenosis in at least 1 coronary artery) being enrolled at 32 centers and assigned to 6 different groups according to their estimated glomerular filtration rate and/or proteinuria. Baseline characteristics, treatment data, and biomaterial including serum, plasma, urine, and DNA samples are collected. Follow-ups are performed at 6, 12, 24, 36, 48, and 60 months. CONCLUSIONS The CAD-REF registry will establish one of the largest ethnically homogeneous cohorts, to date, of clinically and angiographically well-characterized patients with CAD who have all stages of CKD. This approach offers great opportunities for an improved understanding of the underlying pathophysiologic mechanism and clinical impact of CKD in patients with CAD, especially including the identification of clinically relevant risk factors and (genetic and other bio-) markers as a basis to ameliorate future treatment strategies.
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Tirosh A, Golan R, Harman-Boehm I, Henkin Y, Schwarzfuchs D, Rudich A, Kovsan J, Fiedler GM, Blüher M, Stumvoll M, Thiery J, Stampfer MJ, Shai I. Renal function following three distinct weight loss dietary strategies during 2 years of a randomized controlled trial. Diabetes Care 2013; 36:2225-32. [PMID: 23690533 PMCID: PMC3714527 DOI: 10.2337/dc12-1846] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study addressed the long-term effect of various diets, particularly low-carbohydrate high-protein, on renal function on participants with or without type 2 diabetes. RESEARCH DESIGN AND METHODS In the 2-year Dietary Intervention Randomized Controlled Trial (DIRECT), 318 participants (age, 51 years; 86% men; BMI, 31 kg/m(2); mean estimated glomerular filtration rate [eGFR], 70.5 mL/min/1.73 m(2); mean urine microalbumin-to-creatinine ratio, 12:12) with serum creatinine <176 μmol/L (eGFR ≥ 30 mL/min/1.73 m(2)) were randomized to low-fat, Mediterranean, or low-carbohydrate diets. The 2-year compliance was 85%, and the proportion of protein intake significantly increased to 22% of energy only in the low-carbohydrate diet (P < 0.05 vs. low-fat and Mediterranean). We examined changes in urinary microalbumin and eGFR, estimated by Modification of Diet in Renal Disease and Chronic Kidney Disease Epidemiology Collaboration formulas. RESULTS Significant (P < 0.05 within groups) improvements in eGFR were achieved in low-carbohydrate (+5.3% [95% CI 2.1-8.5]), Mediterranean (+5.2% [3.0-7.4]), and low-fat diets (+4.0% [0.9-7.1]) with similar magnitude (P > 0.05) across diet groups. The increased eGFR was at least as prominent in participants with (+6.7%) or without (+4.5%) type 2 diabetes or those with lower baseline renal function of eGFR <60 mL/min/1.73 m(2) (+7.1%) versus eGFR ≥ 60 mL/min/1.73 m(2) (+3.7%). In a multivariable model adjusted for age, sex, diet group, type 2 diabetes, use of ACE inhibitors, 2-year weight loss, and change in protein intake (confounders and univariate predictors), only a decrease in fasting insulin (β = -0.211; P = 0.004) and systolic blood pressure (β = -0.25; P < 0.001) were independently associated with increased eGFR. The urine microalbumin-to-creatinine ratio improved similarly across the diets, particularly among participants with baseline sex-adjusted microalbuminuria, with a mean change of -24.8 (P < 0.05). CONCLUSIONS A low-carbohydrate diet is as safe as Mediterranean or low-fat diets in preserving/improving renal function among moderately obese participants with or without type 2 diabetes, with baseline serum creatinine <176 μmol/L. Potential improvement is likely to be mediated by weight loss-induced improvements in insulin sensitivity and blood pressure.
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Affiliation(s)
- Amir Tirosh
- Brigham and Women’s Hospital, Harvard School of Public Health, Boston, Massachusetts, USA
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